Social science & medicine. Part A, Medical sociology最新文献

This paper presents a review and evaluation of efforts to control dental care costs in the United States. In general, health care costs have become a major concern in the United States; health spending has risen significantly faster than expenditures and prices for other goods and services. The same is not true for dentistry, however. The first section of this paper documents the moderate growth of dental care expenditures and summarizes some of the contributing factors such as increases in health care utilization, productivity, auxiliary utilization and prepayment.

For several reasons, including multiple sources of payment and organizational independence of providers, there has been no comprehensive policy of cost containment in the United States. Nevertheless, there are a multitude of separate efforts aimed directly or indirectly at controlling costs. The most important of these are identified and discussed under three general headings : health care organization and delivery, planning and development, and reimbursement.

After reviewing a variety of cost containment approaches, it is concluded that, overall, they have been effective but with direction could perhaps be more so. There are certain types of approaches which have proved more effective or promising than others. These are identified and discussed as: (1) programs which encourage increased responsibility on the part of the individual for his or her health; (2) community prevention programs; (3) increased productivity through efficient use of auxiliaries and equipment; (4) certain structural factors illustrated by Health Maintenance Organizations, particularly peer review and methods of reimbursing providers which create incentives for efficient dental practice; and (5) prepayment and review of benefits encouraging early dental care. Last, it is noted that care must be taken in designing and administering cost containment programs to avoid dysfunctional side effects such as reductions in access to services.

Few studies have adequately examined the leisure time activities and community participation among dentists. The present report examines the recreational and community activities of 413 practicing dentists in the United States. The findings demonstrated that dentists in the present sample were more recreationally oriented than community oriented. Recreation was most often interpreted as meaning sports activities. Dentists were noticeably different in sports participation from the general male population in that dentists tend to prefer individual or partner sports over team sports. Participation in community activities was analyzed by age and income. Age and participation in community activities demonstrated a positive moderate correlation and participation does not decrease with the age of the dentists.

Health in developing countries is poor. Historically the trend towards ill health was initiated with the advent of slave trade and accelerated later by the colonial expansion of Europe. Dental health is no exception to this. There are many oral conditions which are functions of the poverty and undernutrition which are currently prevalent in developing countries. There are few human or physical resources available to meet these health needs. In most developing countries the dentist to population ratios are of the order of one dentist to 100,000 people or worse. In establishing dental health services in developing countries, there is a danger that attempts will be made to establish the same patterns of organization and to use the same technologies as those used in industrial nations. Because such organizations and technologies are often specific to certain social, political and economic situations their direct transfer for use under totally different circumstances frequently meets with failure. This caveat is particularly critical since there are clear differences between industrialized and developing countries in their patterns of dental disease.

International comparisons of dental health reveal that a much higher proportion of adult New Zealanders wear full dentures than comparable groups in other countries with similar levels of dental disease. Within New Zealand itself, there are marked SES variations in dental treatment against the background of an almost uniform level of disease.

It is argued that the cross-national differences reflect distinct styles of dentistry that have been accommodated within prevailing norms of dental practice. Similar variations exist in the lay culture of dentistry and it is these, together with features of the delivery system, that account for the striking differences in dental treatment by social status in New Zealand.

This paper describes development of a 19-item self-administered Dental Satisfaction Questionnaire (DSQ). Item and factor analyses supported construction and separate scoring of 5 scales (Access. Availability/Convenience, Cost, Pain, and Quality) representing major sources of satisfaction and dissatisfaction with dental care providers and services. A global access scale and an overall dental satisfaction index were also constructed. Scale scores are sufficiently reliable to be used to compare different groups of patients or to study one group over time. Several lines of evidence support the validity of scale scores. Taken together, the results suggest that the DSQ will be useful in general population studies of dental care attitudes, and that dentists may do a better job than physicians in satisfying their patients.

School-based fluoride rinse programs are in the process of rapid and widespread adoption in the United States and represent an opportunity to study the implementation of health technologies by schools. This paper discusses the transfer of this dental preventive health technology as it relates to current diffusion theory.

Findings from a national investigation of the adoption and implementation of fluoride rinse programs are analyzed in relation to two issues: the accuracy of program implementation and the long-term commitment to administering the technology.

Implications of these findings for the delivery of school health services and directions for suggested future research are explored.

Dentistry posed major problems for the European Common Market's efforts to harmonize national arrangements for entry to practice by migrating professionals. The separation of dentistry from medicine in the other 8 member-nations did not occur in Italy. The 1978 Dental Directives passed by the Common Market Council of Ministers included special provisions requiring Italy within 6 years to authorize a new dental role independent from medicine and to create appropriate specific training. The analysis of these events covers three elements. First, the efforts of medical-dentists in Italy to reach consensus or to block a possible internal move toward creation of a separate dental specialty are appraised. Second, the actions of the international liaison committee of national dental associations to seek to deal with the Italian problem through contacts with the Italian medical profession, with the sub-group of Italian medical-dentists, and with the international liaison committee of national medical associations are reviewed. Third, the actions undertaken by Common Market bodies are analysed. This unusual instance of an international governmental authority seeking to force changes in the structure of a profession by impelling action by the government of a sovereign nation highlights the need for further cross-national analysis of the relations between professions and political systems. Whether health professions are more susceptible to international harmonization than technical, scientific, financial or design professions remains an open question, until such research occurs.

This study, essentially a replication of an earlier study of physicians, reports an analysis of the relationship between dentists' new drug information source preferences and attitudes concerning the use of drugs by patients. Data, collected via questionnaire from 78 dentists in a Southeastern state, disclosed that Physician's Desk Reference was the major source used for learning about new drugs. Recommendation by colleagues was chosen as the second most preferred source. No statistical evidence was found to support either of the following hypotheses: (1) dentists preferring professional sources will be less likely to feel that medication advice from nondental sources is acceptable than dentists preferring commercial sources; and (2) dentists preferring professional sources will be more likely to express conservative attitudes about what constitutes legitimate use of drugs by patients than dentists preferring commercial sources. Evidence was found that general practitioners are less accepting of the use of mood-altering drugs than specialists. The results are compared with the previous study and possible explanations for the observed differences are presented.

This paper explores the utility of sick role theory in the development of sociodental indicators. Parsons' sick role model and modifications to the theory by Freidson, Mechanic, Twaddle and Davis are presented within the context of literature reviews on contemporary sociodental and sociomedical indicators. The paper suggests that the social impact of oral conditions should be conceptualized in terms of disruptions in role functioning. Further, initial research should address the basic issue of how oral conditions relate to sick role behavior. Finally, sociodental indicators should be integrated with sociomedical measures to determine the relative impact of oral conditions within the framework of systemic chronic and acute conditions.