Claudia L. Schur

The importance of distinguishing Hispanic subpopulations in the use of medical care.

Rather than analyzing Hispanics as a homogeneous population, this paper uses the 1977 National Medical Care Expenditure Survey in order to make separate national estimates for Cubans, Puerto Ricans, and Mexicans. Utilization of various health services by these three groups is discussed, as well as their insurance coverage, mean annual expenses by source of payment, and health status indicators. The analysis has a descriptive as well as multivariate component and focuses specifically on the use of physician and hospital services and prescribed medicines. It is found that Puerto Ricans are almost twice as likely as Mexicans, and over four times as likely as Cubans, to be covered by Medicaid; Cubans, on the other hand, are most often privately insured. Of the three groups, Puerto Ricans have the highest annual expenses and are most likely to have at least one physician visit. The number of visits for those with a visit, however, is identical across the groups. The paper discusses the policy implications of these findings, as well as the methodologic implications of classifying various Hispanic subgroups into one all-encompassing category.

Language, Sociodemographics, and Health Care Use of Hispanic Adults

This study examines the role of spoken language in access to health care for Hispanic adults. Analyzing the associations between personal characteristics and the use of Spanish as opposed to English reveals that monolingual Spanish speakers were more likely than others to be older, less educated, in poor health, uninsured, and in poverty. Further, Spanish speakers were less likely than English-speaking Hispanics to have a usual source of health care. Persons with no usual source of care were least likely to have seen a physician or to have had their blood pressure checked, whereas those with a regular doctor appeared to have the greatest access. The authors conclude that, whereas language is certainly associated with many barriers to health care, both economic well-being and having a usual source of care are of paramount importance for the Hispanic American population.

Hospital-physician arrangements and hospital financial performance.

OBJECTIVES The introduction of the Medicare Prospective Payment System and the more recent rise of managed care plans have greatly increased the importance of effective hospital financial management. Because physicians play a central role in directing hospital resource use, policies to influence physician behavior and to align physician and hospital interests more effectively are being advocated increasingly. This article evaluates the effect of nine strategies to facilitate physician involvement and integration into the hospital on hospital financial performance. METHODS Data came primarily from the Prospective Payment Assessment Commissions hospital-physician relations survey of 1,485 hospitals and the Medicare Cost Reports. Both ordinary least squares and first differencing models were used to evaluate the effect of physician integration on hospital financial performance. RESULTS Hospitals with lower margins and higher costs were more likely to have implemented strategies to integrate physicians and to modify physician behavior than their counterparts. Analysis using first differencing models indicated that making department heads responsible for the profits and losses had a significant positive effect on margins, whereas including medical staff on the hospitals board and offering physicians management services had a significant negative impact on average Medicare costs. In addition the number of strategies implemented was associated positively with financial performance. The paper also emphasizes the importance of model specification in evaluations of hospital-physician arrangements. CONCLUSIONS Changes in hospital-physician relations may have been one reason why hospitals have been relatively successful at containing costs and retaining profitability in recent years. More research needs to be done on which specific arrangements affect hospital financial performance, as well as their effect on the quality of patient care.

Short report: Migration among persons living with HIV

Data from the first national probability sample of persons with HIV, the HIV Cost of Services and Utilization Survey (HCSUS), are used to examine migration patterns among persons with HIV/AIDS in the USA. Persons with serious illness may choose to relocate to receive better care or support. This migration has implications for the distribution of resources. This study describes the frequency and reasons that persons with HIV move to different communities. An analytic file of 3014 respondents was obtained from the first national probability sample of persons with HIV/AIDS, the HCSUS. A migration section of the baseline questionnaire questioned respondents on their residential history. Persons were defined as movers if they moved across state lines or to a non-contiguous county after knowing they were HIV positive but before the HCSUS baseline interview. Forty percent of movers said that their HIV status was a very important factor in their decision to move. Although earlier studies of limited generalizability found movement among the HIV population from urban to rural counties, this study found only eight percent of HIV migration was from urban to rural counties, just slightly more than the migration from rural to urban counties. In addition, the vast majority of people who were moving were not moving to return home. Major factors in the decision to move included being near caregivers and being in a community with shared needs and interests. Significant numbers of persons also moved to obtain care from a physician knowledgeable in HIV treatment or to get away from discrimination. Financial assistance and the availability of Medicaid also played a prominent role in many decisions to move. Persons with HIV/AIDS are more likely to move than non-infected persons in the general population. Moreover, they are almost twice as likely to be moving out-of-state. Persons with HIV who move are similar to persons with HIV who do not move on most demographic characteristics including age, region of the country, and income.

Connecting The Ivory Tower To Main Street: Setting Research Priorities For Real-World Impact

Health care decisionmakers face increasing pressure to use health care resources more efficiently, but the information they need to assess policy options often is unavailable or not disseminated in a useful form. Findings from stakeholder meetings and a survey of private-sector health care decisionmakers in California begin to identify high-priority issues, the perceived adequacy of current information, and preferred formats and other desired attributes of research. This is a first step in establishing a systematic approach to linking the information priorities of private-sector decisionmakers with those who fund and conduct research.

Local public health capacities to address the needs of culturally and linguistically diverse populations.

Objective: To assess local health department (LHD) capacity to serve diverse populations. Design: Data on 2300 LHDs (National Association of County and City Health Officials 2005 National Profile of LHDs) was linked with 2000 census data to make population profiles that characterized the degree of diversity present in jurisdictions. The LHDs with the most diverse populations were surveyed, and their actions to assess and adjust to the needs of culturally and linguistically diverse populations were examined. Setting: The researchers administered a questionnaire to LHDs by mail. Participants: For the population profiles, 2300 LHDs were included. Nearly 300 LHDs serving jurisdictions across the United States completed the survey. Main Outcome Measures: In the population profiles, diversity was measured through poverty rates, race/ethnicity, linguistic isolation, languages spoken, and immigration. The survey assessed the utilization of approaches for meeting needs of diverse subgroups, including administrative approaches, interpreter services and materials, special programs and partnerships, and workforce training. Results: For each diversity measure, the top decile of LHDs served jurisdictions with at least 20.3% of population in poverty, 3.4% recent immigrants, 43.5% nonwhite population, 4.5% linguistically isolated households, and 32 languages spoken. The vast majority of LHDs collect data on clients to identify needs, but less than 30% have conducted needs assessments. Most also have some form of interpreter services and translated materials, but only one-third do readability testing. The LHDs whose service area populations were the most diverse had a greater number of strategies in place to meet the needs of culturally and linguistically diverse populations, while smaller jurisdictions had fewer. Conclusions: