Reorganizing Health Care Delivery Systems, Volume 21: Problems of Managed Care and Other Models of Health Care Delivery (Research in the Sociology of Health ... (Research in the Sociology of Health Care)

This volume deals with the reorganizing of health care delivery systems: problems of managed care and other models of health care delivery. Issues of how to best organize a health care delivery system are not new, but the amount of interest in this topic in the US (as well as in other countries) has grown in recent decades. Reorganizing health care delivery systems is a concern of many systems of the world, and this volume contains some papers from countries other than the US, although the majority of the papers do relate issues to the US health care delivery system. While most papers relate to structural and organizational factors, the impact of individual patients is not neglected. The volume contains 11 papers, organized into four sections. The sections cover managed care issues and organizational features, special groups of patients and health issues, lessons from other countries, and broader policy concerns and health insurance reform. This book addresses important themes in medical sociology, with papers that range from those with an explicit policy point of view to narrower papers on more specific issues in health care delivery. It aims to contribute to improving our understanding of these issues and provides a sociological focus for the exploration of them. This should make the volume essential reading for medical sociologists and other social scientists studying health care delivery issues. The information should be also helpful to health services researchers, policy analysts and public health researchers. cover.jpg......Page 1 sdarticle.pdf......Page 2 sdarticle_001.pdf......Page 5 sdarticle_002.pdf......Page 7 SURVEYS OF MEMBERS OF HEALTH CARE INSURANCE PLANS: METHODOLOGICAL ISSUES......Page 15 TYPICAL SURVEY METHODOLOGY......Page 16 Problems with Current Survey Methodology......Page 18 Suggested Improvements to Sampling Plan......Page 21 Suggested Improvements to Field Operations......Page 23 Suggested Improvements to Data Analyses......Page 25 DISCUSSION......Page 28 Acknowledgements......Page 29 References......Page 30 INTRODUCTION......Page 32 INSTITUTIONAL CHANGE......Page 34 Diversity in Managed Care Organizational Forms and Practices......Page 36 Data......Page 37 Describing the MC Organization Population......Page 38 What Do We Mean by Managed Care Anyway?......Page 42 DISCUSSION......Page 44 CONCLUSION......Page 45 Acknowledgements......Page 46 References......Page 47 EDUCATION, MANAGED HEALTH CARE EXPERIENCES, AND HEALTH OUTCOMES......Page 50 INTRODUCTION......Page 51 BACKGROUND......Page 52 Comprehensibility......Page 54 Manageability......Page 55 HYPOTHESES......Page 56 Research Context......Page 57 Measures......Page 58 RESULTS......Page 61 DISCUSSION......Page 65 CONCLUSION......Page 68 References......Page 69 THE INFLUENCE OF CLINIC ORGANIZATIONAL FEATURES ON PROVIDERS' ASSESSMENTS OF PATIENT ADHERENCE TO TREATMENT REGIMENS......Page 73 INTRODUCTION......Page 74 BACKGROUND......Page 75 DIABETES......Page 77 DATA AND METHODS......Page 78 AVAILABILITY OF PERSONNEL: WHICH PROVIDERS SEE WHICH PATIENTS?......Page 80 Scheduling and Time Constraints......Page 82 Team Management......Page 83 Clinical Interactions Among Practitioners......Page 85 Medical Charts and Recordkeeping......Page 87 IMPLICATIONS FOR HEALTH CARE DELIVERY SYSTEMS......Page 89 References......Page 91 INNER STRENGTH AND THE EXISTENTIAL SELF: IMPROVING MANAGED CARE FOR HIV+ WOMEN THROUGH THE INTEGRATION OF NURSING AND SOCIOLOGICAL CONCEPTS......Page 94 INTRODUCTION......Page 95 The Impact of Managed Care on HIV/AIDS and Nursing......Page 96 THE CONCEPT OF INNER STRENGTH IN THE HEALTH CARE LITERATURE......Page 97 Related Concepts in Nursing......Page 99 REFINING THE CONCEPT OF INNER STRENGTH......Page 100 METHODS......Page 102 THREE STYLES OF TALKING ABOUT ONE'S INNER STRENGTH......Page 103 Faith Stories: Barbara......Page 104 Character Stories: Mary......Page 106 Uncertainty Stories: Elaine......Page 108 DISCUSSION AND CONCLUSION......Page 109 Implications for the Health Care Delivery System......Page 111 References......Page 112 INTRODUCTION......Page 114 MODELS OF MEDICAL CARE: WHERE DOES CHRONIC DISEASE MANAGEMENT FIT?......Page 116 Dialysis Technology......Page 117 Relevance of Health Promotion and Rehabilitation Models for Dialysis Care......Page 118 Defining the Key Issues of Care......Page 121 Restricting Access to Expert Knowledge......Page 122 Discrediting the Patient as a Responsible Actor......Page 123 Technology as a Potential Catalyst for Rehabilitation......Page 124 CONCLUSION......Page 125 References......Page 127 DELIVERING LONG-TERM CARE IN A CHANGING ENVIRONMENT: THE IMPACT OF MANAGED CARE IN THE UNITED STATES......Page 131 BACKGROUND AND SIGNIFICANCE......Page 132 Study Design......Page 136 Sample Characteristics......Page 138 MANAGED CARE IN THE LONG-TERM CARE SECTOR......Page 140 CONCLUSIONS......Page 142 Acknowledgements......Page 144 References......Page 145 INTRODUCTION......Page 147 The New NHS: Modern, Dependable......Page 148 Reform in the NHS......Page 149 THE WORK OF TRANSLATING POLICY RHETORIC INTO WORKABLE STRUCTURES......Page 150 Local Implementation of Reform: GPs and Managers Working to Create and Maintain Consensus......Page 153 Consensus Strategies: "Fudging" Definitions and Talking Past Each Other......Page 154 Consensus Strategies: Selective Facilitation......Page 157 Consensus Strategies: Managers Working to Establish a Continued Influence......Page 159 Consensus Strategies: Calling Upon Worst Case Scenarios......Page 161 DISCUSSION......Page 162 References......Page 164 INTRODUCTION......Page 167 RELATED RESEARCH AND TESTABLE HYPOTHESES......Page 169 Survey Instrument......Page 170 Health Status: An Endogenous Variable......Page 171 Statistical Modeling Approaches and Techniques......Page 172 Descriptive Statistics of the Study Sample......Page 174 Social Capital as Predictors of Health Status and Health Services Use......Page 176 DISCUSSION......Page 180 CONCLUSIONS......Page 181 References......Page 182 INTRODUCTION......Page 185 LACK OF ACCESS......Page 186 HEALTH DISPARITIES......Page 187 INCREASED COSTS......Page 188 NEGATIVE CLINICAL OUTCOMES......Page 189 CROSS-NATIONAL COMPARISONS......Page 190 UNIVERSAL HEALTH CARE AS A SOLUTION......Page 192 References......Page 194 INTRODUCTION......Page 196 Background: Welfare Reform and Health......Page 197 The State of Oregon: Site of the Oregon Health Plan......Page 199 Segmentation......Page 200 Recruitment......Page 201 Background: Health Status of Families Leaving Welfare......Page 203 The Oregon Health Plan: How it is Perceived......Page 204 Consequences of Being Uninsured......Page 205 Employment Prospects and Insurance......Page 206 Welfare-to-Work Program Assistance in Planning for the Future......Page 208 CONCLUSION......Page 209 References......Page 210 "This book addresses important themes in medical sociology, with papers that range from those with an explicit policy point of view to narrower papers on more specific issues in health care delivery. One of the lessons of the past decade is that no countries in the world are completely satisfied with their health care delivery systems nor do they believe they have resolved the tensions of how to provide access to all to high quality care at a reasonable cost. This volume contributes to improving our understanding of these issues and provides a sociological focus for the exploration of these issues. This makes the volume essential reading for medical sociologists and other social scientists studying health care delivery issues. The information is also helpful for health services researchers, policy analysts, and public health researchers."--BOOK JACKET