A comprehensive study of the efficiency of activities of 5 principle therapeutic-and-preventive institutions (TPI) was conducted in a typical Ural industrial region by using the traditional and newly developed approaches. Both the medical and economic efficiency of their activities was found to be not high in a majority of them. The analysis results were used to work out a scientifically substantiated program for reforming the health care system of the region.
To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities.
The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions.
The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.
This paper focuses upon health status, need for care, and use of health care from 1994/95 to 2000/01 in the Canadian foreign-born population.
Using Statistics Canada's longitudinal National Population Health Survey, descriptive and survival analyses are used to explore immigrant health status and health care.
The health status of immigrants quickly declines after arrival, with a concomitant increase in use of health care services. However, survival analysis of the risk of a change to poor health indicates no difference between immigrants and the native-born. Similarly, there is no difference in the risk of hospital use between the two populations.
The health status of recent immigrant arrivals is observed to decline towards that of the native-born population, while health care utilization increases. However, increased use may not be sufficient to offset declines in health, meaning that need for health care within the immigrant population may be unmet.
Perceived health status, health conditions, and access and barriers to care are important predictors of mortality and the use of services among the homeless. This study assesses these issues by structured interview of 128 homeless adults from San Francisco. Of these adults, 21.1 percent were women (mean age 37 compared to 42 for men). In terms of ethnicity, 38 percent were white; 30 percent were African American; 17 percent were Latino; and 15 percent were Asian/Pacific Islander, Native American/Alaskan, or of mixed ethnicity. Of these adults, 49 percent rated health as poor or fair. Men were four times as likely as women to report their health status as excellent or good. Persons of color were more likely to report unmet needs for shelter, regular meals, employment, and job skills/training. These findings add information on those homeless not often included in research and indicate that these marginalized individuals may be in the poorest health.
A new database developed by the Canadian Centre for Health Information (CCHI) contains 40 key health indicators and lets users select a range of disaggregations, categories and variables. The database can be accessed through CANSIM, Statistics Canada's electronic database and retrieval system, or through a package for personal computers. This package includes the database on diskettes, as well as software for retrieving and manipulating data and for producing graphics. A data dictionary, a user's guide and tables and graphs that highlight aspects of each indicator are also included.
Reducing spatial access disparities to healthcare services is a growing priority for healthcare planners especially among developed countries with aging populations. There is thus a pressing need to determine which populations do not enjoy access to healthcare, yet efforts to quantify such disparities in spatial accessibility have been hampered by a lack of satisfactory measurements and methods. This study compares an optimised and the conventional version of the two-step floating catchment area (2SFCA) method to assess spatial accessibility to medical clinics in Montreal.
We first computed catchments around existing medical clinics of Montreal Island based on the shortest network distance. Population nested in dissemination areas were used to determine potential users of a given medical clinic. To optimize the method, medical clinics (supply) were weighted by the number of physicians working in each clinic, while the previous year's medical clinic users were computed by ten years age group was used as weighting coefficient for potential users of each medical clinic (demand).
The spatial accessibility score (SA) increased considerably with the optimisation method. Within a distance of 1 Km, for instance, the maximum clinic accessible for 1,000 persons is 2.4 when the conventional method is used, compared with 27.7 for the optimized method. The t-test indicates a significant difference between the conventional and the optimized 2SFCA methods. Also, results of the differences between the two methods reveal a clustering of residuals when distance increases. In other words, a low threshold would be associated with a lack of precision.
Results of this study suggest that a greater effort must be made ameliorate spatial accessibility to medical clinics in Montreal. To ensure that health resources are allocated in the interest of the population, health planners and the government should consider a strategy in the sitting of future clinics which would provide spatial access to the greatest number of people.
The extent to which use of medical services by young children could be predicted by mothers' use of medical services and by certain family characteristics has been studied. The study population comprised 591 children two to four years of age in a Swedish rural municipality. Register data on physician visits and prescription drug purchases during 1979 constituted main sources of information. Statistically significant positive associations were found between number of physician visits made by the children and by their mothers and between number of prescription drug purchases made for the children and for the mothers. More physician visits and prescription drug purchases were made for the children of younger mothers than for those of older mothers. Six to eight per cent of the variation in the use of medical services by the young children was explained in multiple regression models including mainly mothers' use of medical care, mothers' age and children's age.
