Social science & medicine
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Social science & medicine · Mar 2002
Market reforms and public incentives: finding a balance in the Republic of Macedonia.
The Republic of Macedonia is undertaking sweeping reforms of its health sector. Funded by a World Bank credit, the reforms seek to improve the efficiency and quality of primary health care (PHC) by significantly strengthening the role of the market in health care provision. On the supply-side, one of the key reform proposals is to implement a capitation payment system for PHC physicians. ⋯ An assessment of the effects that this greater policy environment has on private sector provision identifies opportunities to strategically enhance the reforms. With respect to established market economies, the study finds justification for a greater role for government intervention in private health markets in transition economies. In addition to micro-level payment incentives and administrative controls, marketization in Central and Eastern Europe requires an examination of insurance contracting procedures, quality assurance practices, public clinic ownership, referral practices, hospital privileges, and capital investment policies.
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Social science & medicine · Mar 2002
Comparative StudyMultiple roles and health among British and Finnish women: the influence of socioeconomic circumstances.
Two contrasting hypotheses have been presented to predict women's health variations. The Multiple burden hypothesis predicts that combining a paid job, being married, and having children is likely to be detrimental to women's health. The multiple attachment hypothesis predicts that multiple roles provide attachment to the community, which is likely to be beneficial to women's health. ⋯ The findings are broadly in accordance with the multiple attachment hypothesis. Despite the more generous welfare state and high full-time employment among Finnish women, single lone mothers report poorer health than other women in Finland as well as in Britain. However, in Britain the disadvantaged social position of lone mothers accounts for a greater proportion of their poor health than in Finland.
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Social science & medicine · Mar 2002
Comparative StudyThe impact of hospices on health care expenditures--the case of Taiwan.
Cancer has been the leading cause of death in Taiwan since 1982, with nearly one out of four deaths caused by malignant neoplasm. The huge amount of money being spent in the acute care setting for terminally ill cancer patients does not increase their wellbeing. In this study, we employ an Instrumental Variable (IV) model to correct for the self-selection problem and use population-based insurance claim data to test two null hypotheses: there is no difference in total expenditures between hospice care and conventional care, and that there is no difference in total expenditures between hospital-based hospice care and home hospice care. Both null hypotheses are rejected.
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Social science & medicine · Mar 2002
Representations of far-flung illnesses: the case of Ebola in Britain.
In western cultures lay people are faced with a plethora of far-flung illnesses, relayed to them by the mass media. A number of social scientists have called for scrutiny of the link between people's patterns of thinking concerning such events, and the messages to which they are exposed. Using the outbreaks of Ebola in Africa in the mid-1990s as a vehicle, the study examines how British broadsheets and their readers, and British tabloids and their readers, make sense of this far-flung illness. ⋯ However, group differences exist, and are characterised by a more essentialised vision of Ebola in the tabloids and their readers, in contrast to a focus on structural features linked to Ebola's escalation in the broadsheets and their readers. In terms of the media-mind relationship, beyond the similarities found between media type and their respective readers' ideas, certain key differences exist: While the newspapers make Ebola 'real' by referring to its potential to globalise. as well as to how it can be contained, lay thinkers feel detached from it, and draw an analogy between Ebola and science fiction. This is discussed as a method of symbolic coping on the part of the readers, as well as in terms of the power exerted by media imagery on lay representations of Ebola.
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Social science & medicine · Feb 2002
Comparative StudyFactors determining inpatient satisfaction with care.
The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases. Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of care and services, recommendations/intentions). Patient satisfaction and complaints were treated as dependent variables in multivariate ordinal polychotomous and dichotomous logistic stepwise regressions, respectively. ⋯ Men tended to be more satisfied than women. Other predictors specific for certain dimensions of satisfaction were: married, Karnofsky index more than 70, critical/serious self-reported condition at admission, emergency admission, choice of hospital by her/himself, stay in a medical service, stay in a private room, length of stay less than one week, stay in a service with a mean length of stay longer than one week. The factors associated with inpatient satisfaction elucidated in this study may be helpful in interpreting patient satisfaction scores when comparing hospitals, services or time periods, in targeting patient groups at risk of worse experiences and in focusing care quality programs.