Access to Medical Care for Low-Income Persons: How do Communities Make a Difference?

Andersen, Ronald; Yu, Hongjian; Wyn, Roberta; Davidson, Pamela L.; Brown, E. Richard; Teleki, Stephanie S.

doi:10.1177/107755802237808

Cited by 174 publications

(178 citation statements)

References 26 publications

(17 reference statements)

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“…We found that the mammography implementation rate increased with income level, from 14.3% of housewives to 55.6% of private sector worker group. Two primary reasons may account for the low implementation rate of mammography in low-income patient groups: first, these individuals may not be able to afford the expense of the examination (Ward et al, 2008;Cunningham et al, 2009); and second, these patients are usually residents of poorer regions in which hospitals are unable to buy advanced mammography equipment (Ferrante et al, 2000;Andersen et al, 2002;Barry et al, 2005). A similar finding was made regarding other types of examinations.…”

Section: Discussionmentioning

confidence: 79%

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Wang

Li²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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The impact of income and education level on the clinical and pathologic characteristics, implementation of clinical breast examination (CBE), and treatment patterns of a small population of Chinese female breast cancer patients was studeied in order to provide a theoretical basis and statistical reference for further nationwide research. We included 484 pathologically confirmed female primary breast cancer inpatients of the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from February 2003 to January 2004. All cases were reviewed and relevant information was collected using a designed case report form (CRF). Chisquare tests, rank-sum tests, and Fisher's exact tests were used in the analysis. Our analysis showed that: (1) women in different occupation groups had significant differences in tumor size, pre-operative mammography, surgical options, post-operative estrogen receptor (ER), progestin receptor (PR) and human epidermal growth factor receptor 2 (Her2) status, and post-operative radiotherapy and chemotherapy (P < 0.05); and (2) women with different education levels had statistically significant differences in tumor size, post-operative ER, PR and Her2 status, and post-operative chemotherapy, radiotherapy, and endocrine therapy (P < 0.05). In Xi'an, China, women in low-income occupations or with low education levels are more likely to have advanced tumor stages at presentation, lower implementation rate of clinical breast examination, and less treatment.

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Section: Discussionmentioning

confidence: 79%

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Wang

Li²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Uninsured children have less access to primary care and outpatient services, both before admission and after discharge from the hospital. 25 Prior studies, however, found no differences between uninsured and insured children in hospitalization rates, [26][27][28] LOS, [26][27][28] or the quality of asthma management. 29 Another difference could be in the availability of a medical home for children in large urban areas.…”

Section: Discussionmentioning

confidence: 95%

Equivalent Lengths of Stay of Pediatric Patients Hospitalized in Rural and Nonrural Hospitals

et al. 2004

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ABSTRACT. Background. Many children receive their care at local hospitals outside of a large urban area. There may be differences in the length of stay (LOS) between children hospitalized in rural versus urban hospitals. This study compared the differences in LOS, conditional LOS (CLOS), odds of prolonged stay, and 21-day readmission rates for children with 19 medical conditions and 9 surgical procedures admitted to rural, community, and large urban hospitals.Methods. Discharge records for the hospitalizations of children 1 to 17 years of age were obtained from the New York Department of Public Health Statewide Planning and Research Cooperative System and the Pennsylvania Health Care Cost Containment Council for April 1996 to July 1998. The 19 medical and 9 surgical conditions were identified with the principal condition and procedure codes. Hospitals were classified into 1 of 5 geographic categories on the basis of United States ruralurban continuum codes, ie, large urban, suburban, moderate urban, small urban, or rural. LOS was defined as the period of time between hospital admission and discharge. Readmission rates were calculated for 21 days after discharge from the hospital. A prolonged stay for each condition was defined as any admission lasting beyond the prolongation point, or the day at which the rate of discharge began to decline, as determined with the Hollander-Proschan statistic. This aspect of LOS describes the ability of providers to treat uncomplicated cases of that specific principle diagnosis. CLOS, as a marker for the management of complicated cases, was defined as the LOS beyond the prolongation point. Cox and logistic regression models were developed to describe the geographic effects on the 4 outcome variables, after severity adjustment with 32 demographic and 11 comorbidity variables and adjustment for hospital clustering.Results M ore than 20% of children in the United States reside in rural communities, 1,2 and rural hospitals constitute 16% to 34% of all hospital discharges. Whether these children receive efficient treatment when hospitalized is not known. The adult literature indicates that there may be differences between rural and urban locations in the management of some adult diseases. Keeler et al 3 found that, for 5 medical conditions, patients treated at rural hospitals had excess mortality rates and worse quality of care, compared with patients treated at urban hospitals. Similar results were observed for the management of acute myocardial infarction 4,5 and depression. 6 These differences may center on the amount of technology needed to treat the patient, how quickly knowledge about the disease changes, and how critical specialist management is for appropriate treatment of the patient. 3 However, rural hospitals have been shown to give similar quality of care to adults hospitalized for treatment of community-acquired pneumonia 7,8 and for general surgical procedures. 9 Potential differences between rural and urban hospitals may influence the efficiency of care received by hosp...

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“…Los estudios dilucidaron cuestiones como: los factores que afectan el acceso/utilización de servicios de salud (10,(14)(15)(16)19,21,22,25,27,30,41); las diferencias, desigualdades e inequidades en la utilización de servicios de salud (8,12,17,18,31,32,34,35,37); los roles del seguro en la utilización (9,20,26,28,29); las barreras para el acceso/utilización (11,13,23,24,40); las vivencias y expectativas sobre la utilización (33,38,39) y los patrones de uso (36).…”

Section: Tabla 1 Características De Los Estudiosunclassified

“…Las variables del sistema de salud fueron medidas en 41,9 % de los estudios cuantitativos (8,10,11,13,14,16,19,(23)(24)(25)(26)29,37), encontrándose que los factores más estudiados fueron: disponibilidad de recurso humanos y físicos, tipo de servicios, tiempos de espera para obtener una cita, tiempo de espera en el consultorio y políticas institucionales, respectivamente.…”

Section: Figura 1tipo De Variables Explicativas Del Objeto De Estudiounclassified

“…El 45,1 % incluyó factores de esta naturaleza (9,11,12,14,15,17,19,21,22,26,27,29,31,34). El entorno familiar fue el más estudiado (ingreso familiar, estructura familiar, recursos económicos, educación) seguido del económico (tasa de desempleo, ingreso, ingreso per capita, desigualdad en el ingreso, entre otras), el cual fue estudiado en 4 de los 11 estudios que abordaron estas variables.…”

Section: Figura 1tipo De Variables Explicativas Del Objeto De Estudiounclassified

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Revisión sobre la Utilización de Servicios de Salud, 1996-2006

Ruiz-Rodríguez

Valdez‐Santiago

2008

Rev. salud pública

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RESUMENObjetivo Revisar, en artículos publicados durante el período 1996-2006, cuáles son los supuestos ontológicos, metodológicos y epistemológicos prevalentes en los estudios de la utilización de servicios de salud. Material y métodos Para asegurar la identificación de estudios relevantes se realizó la búsqueda de los artículos indexados en la base de datos PubMed. Resultados Un total de 34 artículos fueron incluidos en el análisis final. El 70,6 % fueron realizados en Estados Unidos de América, 30 % trató con población en desventaja social y el objeto de análisis más frecuentemente estudiado fue la visita médica (50 %). Treinta y un estudios (91,2 %) abordaron el problema de estudio desde la aproximación cuantitativa y tres desde la cualitativa. Las variables más estudiadas desde la perspectiva cuantitativa fueron las del individuo en 90,4 % de los estudios, seguidos de las variables del contexto (45,2 %) y del sistema de salud (41,9 %).Los análisis estadísticos de los estudios de corte cuantitativo se realizaron utilizando modelos de regresión múltiple y sólo 19,4 % de los análisis incorporaron modelos que captan la complejidad del fenómeno de la utilización. Análisis del discurso y de contenido fueron realizados en los estudios cualitativos. Conclusiones Los hallazgos reflejan el carácter reducible del fenómeno de la utilización a términos objetivos y necesariamente tiende a oscurecer que la utilización es una es una practica social integradora. Se requiere una perspectiva más amplia para abordar el fenómeno de la utilización. El uso de aproximaciones cuantitativas y cualitativas nos arroja resultados distintos que ayudan a configurar una visión integral de una misma problemática.Palabras Clave: Servicios de salud, accesibilidad, utilización (fuente: DeCS, BIREME). ABSTRACTObjective Reviewing research papers published during 1996-2006 regarding ontological, methodological and epistemological proposals regarding the use of health services.

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Access to Medical Care for Low-Income Persons: How do Communities Make a Difference?

Cited by 174 publications

References 26 publications

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Equivalent Lengths of Stay of Pediatric Patients Hospitalized in Rural and Nonrural Hospitals

Revisión sobre la Utilización de Servicios de Salud, 1996-2006

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