Jack Elinson

Toward sociomedical health indicators

The various forms of mortality data and biomedical measures of morbidity have become inadequate measures of the level of health in economically developed countries. Measures of functional physical capacity have some advantages but do not reflect physical impairment. Current attempts to develop sociomedical health indicators include: measures of social disability; typologies of presenting symptoms, which have been used to estimate probable needs for care; measures which focus on behavioral expressions of sickness; research based on operational definitions of ‘positive mental health’, ‘happiness’ and perceived quality of life; assessments of met and unmet needs for health care, which are measures of social capacity to care for the sick.Sociomedical indicators reflect both objective conditions and social values. They are policy-oriented, serving as mobilizing agents for sociopolitical pressures concerned with raising the overall level of health of the population.

Developing a Measure of Unmet Health Care Needs for a Pediatric Population

BACKGROUND Quantified measures of unmet health care needs can be used to evaluate health care interventions, assess the impact of managed care, monitor health status trends in populations, or assess equity of access to medical care across population subgroups. Such a measure needs to be simple, relatively easy to obtain, inexpensive, and appropriately targeted to the population of interest. OBJECTIVE To develop a measure of unmet health care needs that is specifically targeted to a pediatric population. SUBJECTS Study participants consisted of children, aged 1 to 5 years (n = 1,031), and adolescent mothers, aged 13 to 19 years (n = 172), predominantly from poor, minority families in New York City. RESEARCH DESIGN Based on a measure, the symptoms-response ratio, developed for all age groups, this study replicated Taylors procedures specifically for children and adolescents. Respondents were asked if they had experienced a set of physical symptoms and if they saw a doctor in response. A panel of pediatricians rated the same symptoms as to whether health care should be sought. RESULTS The measure achieved adequate inter-rater reliability and good construct validity. The childrens overall use of health services did not differ from the pediatric panels expectations, but with differing degrees of unmet needs by symptom. Adolescents sought care less often than the expert panel members believed they should. CONCLUSIONS The symptoms-response ratio provides a good balance of a simple and inexpensive measure while yielding a fair estimate of unmet needs for primary care. This analysis created a pediatric measure targeted to the needs of young children and adolescent females.

Predictions of outcome in psychoanalysis and analytic psychotherapy

The written records of 1,348 patients treated at Columbia Universitys Psychoanalytic Clinic and the responses of therapists to a follow-up questionnaire were studied to relate clinical change and predictions of outcome made at the time of admission. Predictions were associated with the type of treatment offered, with the function of the observer, and the completion of long-term analysis.

Strategy and tactics of evaluating a large-scale medical care program.

This report describes the evolution of an evaluation unit organized to assess the impact of a changing hospital care program upon the community it serves. Evaluation activities have been developed to suit the specific characteristics of the program to be evaluated and also to provide continuous, in contrast to single-shot, appraisals of programmatic change. Methodological problems encountered in defining and developing the overall program of evaluation are reviewed. The rationale for the organization of a clinical assessment team— one of the component evaluation activities—is also described.

Response by a low income population to a multiphasic screening program: A sociological analysis

Abstract This paper assesses factors related to utilization of an innovative automated multiphasic health screening program in an inner city area. Data are based on household interviews with 1,351 adults from five universes: residents of the low income community the program was trying to reach; persons with appointments for health tests; persons who broke or cancelled appointments; screenees soon after being tested; and screenees several months later. Three areas of patient noncooperation at which the program was most vulnerable—utilization, appointment breaking, and failure to follow-up the tests with a physician visit—are discussed in terms of incentives and barriers for participation.

Sex differences in medical practice in Argentina

Abstract This report presents some data about demographic and professional characteristics of a sample—454 males and 98 females—of physicians in the city of Buenos Aires, Argentina. The analysis of the age structure showed women as younger and as an increasing component of the profession. Female physicians tended to be limited in their selection of specialties, mainly in the older groups. The earnings of women were less, and a larger proportion of women had their income from salaries: they also were more dissatisfied with their incomes. The representation of women in teaching was smaller and mostly in lesser positions. A question about desirable attributes in an ideal personal physician was answered similarly by both groups. Women were less likely to think that sex, religion and national origin made a difference in the quality of medical care, and were less likely to feel that prestige and authoritarianism were desirable attributes.

Towards Sociomedical Health Indicators

The stagnation of total mortality rates over relatively long periods of time in economically developed countries has reduced the value of mortality rates as indicators of the health status of populations in these countries. The insensitivity of mortality rates is quite noticeable in the United States where there is little to suggest that the increase in health services over recent years has resulted in improvements in the level of health. Even the infant mortality rate, long regarded as the most sensitive index of the level of health, is no longer a particularly useful indicator, despite the fact that the infant mortality rate of the United States suffers in comparison to that of many industrial nations [13]. The principal residual value of infant death rates is to reveal contrasts in health status within limited geographic areas as in large cities, as exemplified by a recent analysis in New York City [27]. Mortality rates are also useful for the assessment of specific diseases, but the present behavior of mortality rates have made moot the value of statistics of deaths from all causes as a measure of health in countries like the United States. The usefulness of biomedical indicators for population — based measures of health status is declining.

A survey of family medical care under three types of health insurance

Abstract The major findings of the survey may be summarized as follows: First, the sample of families belonging to the Kaiser Foundation health plan had as much in-hospital care, and somewhat more office and home care, than did the families covered by New Jersey Blue Cross-Blue Shield and by the General Electric health insurance. Second, although the Kaiser plan subscribers lived in the San Francisco Bay area, where the price of medical care is high, the total cost of their health insurance and their medical care was no higher than for the other community-rated plan, that is, for New Jersey Blue Cross-Blue Shield. Third, although New Jersey Blue Cross-Blue Shield is largely an in-hospital plan, it covered nearly the same proportion of the familys bill for medical care as did the ‘comprehensive’ General Electric major medical plan. However, the latter gave somewhat better protection to the important group of families who had very high medical bills during the survey year.