ABSTRACT
Having a source where medical services are regularly received is an antecedent to securing high quality medical care; it facilitates access and indicates that the individual is not alienated from the health care delivery system. In this paper we develop models to characterize individuals, both children and adults, who claim a regular source of care. The models are estimated using a logit analysis (since the dependent variable is 0-1) applied to survey data on residents of East Palo Alto, California. These data indicate that in this low-income, predominately black population the most important factor influencing whether a child will have a regular source of medical care is whether the parents have a regular source. For adults, the anticipated need for care (as measured by health status), time in community, and sex were all found to be important. The type of individual least likely to have a regular source of care is a low-income, unmarried male who is in good health and is a recent arrival to the community. The individuals most likely to need easy access to medical care and continuity of care are most likely to have a regular source of care, and vice versa.
Subject(s)
Health Services/statistics & numerical data , Adult , Child , Female , Health Services Accessibility , Health Status Indicators , Humans , Male , Models, Theoretical , Patient Acceptance of Health Care , Socioeconomic Factors , Statistics as TopicSubject(s)
Costs and Cost Analysis , Hospitalization , Length of Stay , Adult , Aged , Death , Diagnosis , Emergencies , Female , Financing, Government , Hospital Units , Hospitals, Teaching , Humans , Insurance, Health , Internship and Residency , Male , Marriage , Middle Aged , Models, Theoretical , Sex Factors , Surgical Procedures, Operative , United StatesABSTRACT
The results of an evaluation of a predischarge utilization review program [PDUR] for Medicaid Patients are presented. A group of hospitals in Allegheny County, Pennsylvania, participated in this program on a voluntary basis prior to the program's being mandated statewide. All other hospitals in the county experienced retrospective review of Medicaid cases. Our analysis incorporates both types of hospitals in a quasi-experimental design. We found that during the period studied the length of stay of Medicaid patients fell proportionately more than that of the Blue Cross patients in both groups of hospitals; the relative decrease in the length of stay began to occur prior to the introduction of the PDUR program, but no differential effect of the PDUR review process could be demonstrated. The decline in the length of stay was, however, more continuous and smooth in those hospitals participating in the program.
Subject(s)
Hospitals/statistics & numerical data , Length of Stay , Utilization Review , Blue Cross Blue Shield Insurance Plans , Evaluation Studies as Topic , Medicaid , Pennsylvania , Regression AnalysisABSTRACT
Pharmacists are thought to play a central role in providing information and advice on health to lower income and other socially disadvantaged groups. However, recent evidence suggests that social biases exist in the spatial distribution of urban pharmacies. Such biases would severely limit the accessibility of the poor and the nonwhite to pharmacy services. To test the general nature of this evidence, we used multiple regression techniques to assess the simultaneous influence of several ecological and socioeconomic variables on the location of pharmacies in Pittsburgh and Omaha. After controlling for the influence of physicians, hospitals, commercial activity, population, and other variables thought to affect pharmacy location, we were unable to detect any evidence of a direct association between pharmacy location and the socioeconomic or demographic (other than total population) characteristics of areas in either city.
