Social science & medicine. Medical economics最新文献

It is proposed that concepts and results emerging in the 15 year history of the social indicators movement can contribute to the design and implementation of the information systems that will be required if primary health care is to be extended to all people by the year 2000. an ambitious goal set by a recent international conference. Six methodological themes are identified and discussed. These stress the importance of: (1) including normative outcome measures among the indicators. (2) tapping both objective health conditions and subjective perceptions. (3) incorporating theoretical models of how the health care system works. (4) organizing results in a set of health ‘accounts’ which have certain pre-specified relationships to one another, (5) describing key health phenomena at several different levels of specificity and (6) devoting substantial attention to evaluating and improving data quality. These six themes can be used both as guiding principles to shape the development of health information systems and as criteria for evaluating such systems.

After recognizing the absence of Marxist conflict perspectives in classic surveys of public finance and explanations of public support for medical care. a conflict perspective is suggested. O'Connor's work is drawn upon for the framework suggested here. In addition, the suggested framework places emphasis upon class struggle within neo-imperialist monopoly capitalism functioning in a world political economic system. Key components in this struggle are seen as national states, their component and ruling class structures, multinational corporations, and a supporting cultural hegemony. The nation state is seen as collecting and disbursing taxes and other financing to attempt to (1) provide favorable conditions for capital accumulation by the bourgeoisie and (2) integrate the potentially rebellious working class through a variety of cultural as well as welfare and service programs and. when necessary, repression. State financing of medical care is then considered within this perspective. As monopoly capital comes to require ever larger amounts of state financing, ruling class pressures develop to cut back on public support for services to the ‘non-productive’ portions of the population—the unemployed. those on welfare, the elderly, etc. The paper concludes with some action strategies and suggestions.

‘Medicine in the community’ is the name given in Cuba to the dominant model for health services organization at the area and sector levels in the regionalized structure of Cuban health promotion. The recent historical evolution of the model is here analyzed in terms of ideological and structural factors. From this perspective, the origin of medicine in the community is found to be related to a Cuban critique of community medicine in capitalist societies. But the substantive evolution of the concept is principally explained by reference to a critique of revolutionary Cuban health organization itself. The strength of this Cuban critique and also the strength of the consequently formulated model appear to be related to (1) social constituency formation in prior revolutionary years, (2) administrative separation of community health centers (or area polyclinics) from hospital administration. (3) commitment by the Ministry of Public Health to the area polyclinic as the focal unit of organization and (4) trends in Cuban society toward greater institutionalization, decentralization, and democratization of social forms. These trends coincided with increasing vitality of local government generally. The general elements of the model of medicine in the community are described and some implications are discussed.

The revolutionary regime in Nicaragua has made great strides toward the achievement of the central goals of equity of access to health services, emphasis on preventive rather than curative services. and encouragement of community participation. Nevertheless, during the first year of the regime choices were made which were inconsistent with the full achievement of these goals. Equity of access increased much more for urban than rural areas and major efforts in hospital reconstruction and education of physicians began. This article suggests that as militant Sandinistas take more important roles in the Ministry of Health, a shift in emphasis is possible—especially if budgetary constraints are taken into consideration.

The major issue of health care financing in China is how to allocate limited resources to provide effective health care services for a population of about 900 million. There are three major types of health care insurance coverage in China: (1) public expenses medical insurance, (2) labor medical insurance and (3) cooperative medical service. The strategies for cost containment in China include the visit fee. referral system, herbal medicine and hospital payment system. The role of the central government is minimum in direct subsidies. The central government emphasizes the maximum community participation and involvement in health services. The general implications of the Chinese experiences may be useful concepts to be considered by developing countries.

Little research has focused on the factors affecting use of components of primary health care services, particularly in developing countries. This study examines the patterns of usage of child health care provided for preschoolers by modern public, modern private and traditional health practitioners as well as by self treatment. A simultaneous logit framework is used to study the determinants of choice among these four child health service alternatives. The analysis is based on the Bicol Multipurpose Survey, conducted in one of the poorest regions of the Philippines as a multivisit household and community survey of 1906 households and 100 communities, representative of the three major provinces in this region.

For approximately the last 20 years a nationwide movement in mental health policy has favored the deinstitutionalization of patients previously consigned to mental institutions, and one manifestation of this movement has been consideration of opportunities to consolidate and/or close some state mental institutions. This study focuses upon the regional economic impact of one proposed consolidation in New York State, that of the Utica and Marcy Psychiatric Centers, and it provides a method of analysis which should be useful for other states where facility consolidation has become necessary.

The study develops a conventional regional trade multiplier model which is utilized to estimate the regional (Utica-Rome SMSA) economic impact of the operations of the two hospitals, i.e. the regional income generated. The study also notes the contraction of operations of the two centers during the 1970's. and generates estimates of the regional income lost annually in recent years as a result. In addition, the study concludes that the large number of patients discharged into the community as the result of deinstitutionalization imposes a financial burden on the region of several million dollars annually. Finally, the study provides rough estimates of the regional income losses that would result from the closure of the Utica Psychiatric Center.

It is concluded that institutional closure and/or consolidation in some form is an inevitable and fiscally responsible consequence of continued deinstitutionalization. The critical unresolved question involves the continued development of an effective community-based program network as a necessary alternative to institutionalization. The ultimate impact on regional economies of such consolidations depends upon the pace at which community programs are developed, and the extent to which local governments are forced to assume financial responsibility for them.

Regression analysis of a cross section of 1113 nonfederal short-term U.S. hospitals is used to identify contributions of various exogenous factors to hospital employment of residents. Teaching hospitals are excluded from the analysis. Residents are assumed to be inputs into production of both hospital services and private physicians' services. Case-mix and other hospital characteristics, hospital product demand influences, factor supply variables, and physician market and medical staff characteristics are all shown to influence resident employment. The empirical findings are discussed in the light of hospital reimbursement and regulatory issues, health manpower strategies, and the role of physicians in hospital decision making.