State funding of comprehensive primary medical care service programs for medically underserved populations.

Rosenbaum, Sara; Hawkins, Daniel; Rosenbaum, Ellen; Blake, Sandy

doi:10.2105/ajph.88.3.357

Cited by 19 publications

(4 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(Ware, Kosinski, and Keller 1996) Community‐and state‐level data were obtained from a number of sources (see Table 1) and merged in with CTS data. Measures of the strength of the local safety net were per capita visits to community and migrant health centers (CMHCs), per capita visits to public and teaching hospital outpatient departments, per capita number of physicians (generalist or all patient care physicians) in the community, state and federal funding for primary care services for the medically underserved (Rosenbaum et al 1998), and mean hours per month of charity care reported by physicians in the community responding to the CTS physician survey (Cunningham et al 1999). Social capital measures were race‐specific Gini indices of income inequality and housing segregation (Harrison and Weinberg 1990), plus community‐level rates of being uninsured.…”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family‐Level Factors

Saver

Doescher

Symons

et al. 2003

Health Services Research

View full text Add to dashboard Cite

Objective. To evaluate the influence of community-and family-level factors on racial/ ethnic disparities in the uptake of nongroup (individual) health insurance. Data Sources. Responses to the 1996-1997 Community Tracking Study Household Survey plus community-level descriptors from several sources including census data, the Area Resource File, and community and migrant health center Medicare cost reports. Study Design. Logistic regression was used to compare families in which at least one person had nongroup health insurance to families without nongroup insurance in which at least one person was uninsured. Sequential models were constructed examining family-and community-level factors. Results. Twenty-three percent of families with otherwise-uninsured persons purchased nongroup insurance, ranging from 11% to 41% among the 60 communities sampled. Disadvantaged minority group members, especially Spanish-speaking Hispanics, had half or less the odds of whites of purchasing nongroup insurance. Education had a weaker association with purchasing nongroup insurance among minority group members than among whites. Community-level factors had minimal effect on disparities in uptake, although greater housing segregation was associated with lower uptake among blacks. Conclusions. Minority group members are much less likely to purchase nongroup insurance than whites. Family income and community factors do not explain this gap. Programs aimed at stimulating voluntary insurance purchase will continue to underenroll disadvantaged minorities if nonfinancial barriers to acquiring insurance coverage, including the interplay between race/ethnicity and education, are not better understood and addressed.

show abstract

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family‐Level Factors

Saver

Doescher

Symons

et al. 2003

Health Services Research

View full text Add to dashboard Cite

show abstract

“…However, international differences also exist in the extent of the coverage of populations with strong primary health care systems 19. Despite this, much can be learned from different systems about cost effective methods of organising health care, and much of Europe is observing developments in the NHS with interest.…”

mentioning

confidence: 99%

Evaluation of outreach clinics held by specialists in general practice in England

Bond

Bowling²,

Abery³

et al. 2000

Journal of Epidemiology &Amp; Community Health

View full text Add to dashboard Cite

Objectives-To measure the processes of care, health benefits and costs of outreach clinics held by hospital specialists in primary care settings. Design-The study was designed as a case-referent (comparative) study in which the features of 19 outreach clinics (cases) were compared with matched outpatient clinics (controls). The measuring instruments were self administered questionnaires. Patients were followed up at six months to reassess health status. The specialties included in the study were cardiology, ENT, general medicine, general surgery, gynaecology and rheumatology. Setting-Specialist outreach clinics in general practice in England, with matched outpatient clinic controls. Subjects-Consecutive patient attenders in the outreach and outpatient clinics, their specialists, the outreach patients' general practitioners, practice managers and trust accountants. Patients' response rate at baseline: 78% (1420). Main outcome measures-Patient satisfaction, doctors' attitudes, processes and health outcomes, costs. Results-Outreach patients were more satisfied with the processes of their care than outpatients, their access to specialist care was better than that for outpatients and they were more likely to be discharged. Doctors reported that the main advantages of the outreach clinic were improved patient access to specialists and convenience for patients, in comparison with outpatients, and most GPs and specialists felt the outreach clinic was "worthwhile". At six month follow up, the health status of the outreach sample had significantly improved more than that of the outpatients on all eight sub-scales of the HSQ-12, but this was probably because of their better starting point at baseline. The impact of outreach on health outcomes was small. The NHS costs of outreach were significantly higher than outpatients. An increase in outreach clinic size would reduce cost per patient, but would lead to the loss of most of the clinics' benefits. Conclusions-While the process of care was of higher quality in outreach than in outpatients, and the eYciency of care was also greater in the latter, the eVect on patients' health outcomes was small. Responsiveness to patients' views and preferences is an essential component of good quality service provision. However, the greater cost of outreach raises the issue of whether improvements in the quality and eYciency of health care, without a substantial impact on health outcomes, is money well spent in a publicly funded health service. On the other hand, the real costs of outreach in comparison with outpatients clinics can probably only be truly estimated in a longitudinal study with a resource based costing model derived from documented patient attendances and treatment costs over time in relation to longer term outcome (for example, at a two year end point).

show abstract

“…Though decentralization is often portrayed as a largely technical matter (5,6,10,11), we argue that the political context in which decentralization takes place frames its implementation. In the United States, for example, it has recently been demonstrated that politically determined underfunding-not technical failures-mars the ability of decentralized health services to provide high-quality, comprehensive, accessible care for the medically underserved (12,13).…”

mentioning

confidence: 99%

To Decentralize or Not to Decentralize, is That the Question? Nicaraguan Health Policy under Structural Adjustment in the 1990s

Birn¹,

Zimmerman²,

Garfield³

2000

Int J Health Serv

View full text Add to dashboard Cite

Since 1990, health services decentralization in Nicaragua has been accompanied by structural adjustment, resulting in reduced equity and accountability. Sandinista efforts in the 1980s to extend access to primary care and reduce class and regional disparities in the delivery of health services were accompanied by modest attempts to increase local-level accountability and responsiveness. The escalation of war in the late 1980s transformed this effort into greater de facto decentralization. Over the past decade, Nicaragua has used decentralization policy to restructure the health system through health spending cuts and the favoring of curative over preventive services; privatization and the promotion of user fees; and confusion of lines of accountability. The authors analyze the 1990s' health policies in Nicaragua, paying particular attention to the blending of decentralization policy with the fiscal and administrative reforms advanced by the International Monetary Fund, World Bank, and other international agencies. They conclude that analyzing decentralization as a sector-specific reform that can be ameliorated through technocratic modifications is insufficient. A full understanding of the problems and possibilities of decentralization requires an analysis of the political and economic context that conditions these policies.

show abstract

State funding of comprehensive primary medical care service programs for medically underserved populations.

Cited by 19 publications

References 4 publications

Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family‐Level Factors

Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family‐Level Factors

Evaluation of outreach clinics held by specialists in general practice in England

To Decentralize or Not to Decentralize, is That the Question? Nicaraguan Health Policy under Structural Adjustment in the 1990s

Contact Info

Product

Resources

About