Social science & medicine
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Social science & medicine · Aug 2003
Pharmaceutical reform and physician strikes in Korea: separation of drug prescribing and dispensing.
Before the recent pharmaceutical reform in Korea that mandates the separation of drug prescribing and dispensing, physicians and pharmacists both prescribed and dispensed drugs, resulting in the overuse and misuse of drugs. The pharmaceutical reform attempts to change the provider's economic incentives by eliminating the providers' profit from drugs that have been a major source of their income. ⋯ However, physician strikes forced the government to modify some critical elements of the reform package and to raise medical fees substantially to compensate for the income loss of physicians. Lack of a strategic plan of implementation, failure to appreciate the change in the paradigm of health policy process, and failure to convince consumers of the benefits of the reform, are the major reasons that the historic reform of the separation of drug prescribing and dispensing has resulted in greater social cost than expected.
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We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. ⋯ Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.
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Social science & medicine · Jul 2003
Layperson and physician perceptions of the malpractice system: implications for patient safety.
The malpractice tort system functions upon the assumption that the medical profession defines its own standard of care. Hence, clinical assessments should theoretically mirror legal ones. However, if there is a conflict between the two, this conflict may reflect a perceived bias of the system either for or against a party. ⋯ These results were consistent overall and when parsing assessments by case verdicts. Thus, laypersons and physicians may perceive a similar bias toward plaintiffs in the malpractice system. If these results can be generalized, the malpractice system may be inducing behavior that has a negative impact on patient safety.
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Social science & medicine · Jun 2003
Variation in physicians' definitions of the competent parent and other barriers to guideline adherence: the case of pediatric minor head injury management.
A lack of consensus regarding the definition of even an everyday term can affect physician adherence to clinical guidelines using that term. We demonstrate this by taking, as an illustrative case, the American Academy of Pediatrics' minor head injury (MHI) management guidelines, which generally recommend at-home observation by a "competent" parent (or the equivalent). The recommendation assumes consensus among physicians as to what parental competence comprises. ⋯ Parental competence is not a unitary construct interpreted similarly by all physicians. Subgroups with distinct models may exist; training and specialization may be key variables. To decrease MHI management variation, guidelines should specify parental competence factors to be considered; they may need to be tailored to different physician subgroups.
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Social science & medicine · May 2003
Implications of women's work for child nutritional status in sub-Saharan Africa: a case study of Nigeria.
The study examines the relationships between women's work and child nutritional status (stunting and wasting) of 5331 Nigerian children aged 0-59 months, using data from the 1990 Nigerian Demographic and Health Survey. In defining women's work, the study considers whether women earned cash from their work and carried their children to work in order to assess the importance of childcare and income, which are the principal pathways through which women's work affects child nutritional status. The study also examines infants and children differently in order to assess the influence of child's age on nutritional status. ⋯ During childhood, higher birth weight, immunization, and having a Christian mother reduced stunting and wasting. Children in wealthy households are less likely to be stunted, while mother's education and being a higher parity child increased stunting. Also during childhood, having a Christian mother reduced wasting while recent episodes of fever increased wasting.