Health services research
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Health services research · Aug 2001
Comparative StudyService delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness.
This study evaluated the influence of features of community social environment and service system integration on service use, housing, and clinical outcomes among homeless people with serious mental illness. ⋯ Community social capital and service system integration are related through a series of direct and indirect pathways with better housing outcomes but not with superior clinical outcomes for homeless people with mental illness. Implications for designing improved service systems are discussed.
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Health services research · Jul 2001
Multicenter Study Comparative StudyRacial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care.
This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. ⋯ Health plans need to pay increased attention to racial/ethnic differences in assessments of care. This study's finding that language barriers are largely responsible for racial/ethnic disparities in care suggests that linguistically appropriate health care services are needed to address these gaps.
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Health services research · Jun 2001
Comparative StudyChanges in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women.
To conduct the first national study that assesses whether the Medicaid expansions for pregnant women, legislated by Congress over a decade ago, met the policy objectives of improved access to care and birth outcomes for poor and near-poor women. ⋯ The expansions in Medicaid lead to significant improvements in prenatal care utilization among women of low socioeconomic status. The emerging lesson from the Medicaid expansions, however, is that increased access to primary care is not adequate if the goal is to narrow the gap in newborn health between poor and nonpoor populations.
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Health services research · Apr 2001
Comparative StudyComparison of indicators assessing the quality of drug prescribing for asthma.
To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. ⋯ Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an individual patient level. Caution is needed when using such prescribing indicators to identify low adherence to guidelines. Further validation studies using a gold standard comparison are needed to define the best possible indicator.
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Health services research · Dec 2000
Comparative StudyUninsured status and out-of-pocket costs at midlife.
To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period. ⋯ The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.