This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
This paper reports register data concerning somatic and psychiatric hospital care on 117 battered women who were identified in a surgical emergency department and offered a treatment program. Data were collected during a period of 10 years before to 5 years after the battering in question. It was concluded that the battered woman seeks hospital care much more than the average woman of the same age. It is, however, not only traumatic injuries that bring her to the hospital, but also medical, gynecological, psychiatric, and unspecified disorders and suicide attempts. In this study it was hypothesized that this overuse of hospital care reflects the situation at home characterized by ongoing battering and other psychosocial problems. During the 5 years following the battering, the women did not show any signs of reducing their use of hospital care. It is alarming that this high use of medical care continues over years, and doctors should consider battering as one possible explanation for this phenomenon.
The aim of the present study was to describe the Norwegian adult population according to: 1. number of teeth present, 2. demand and utilization of dental services, 3. travel time from home to the dentist, 4. dental health behaviour, 5. fear for dental treatment. The analyses were performed on a set of national data collected in 1989, which was representative of the non-institutionalized Norwegian population 20 years and above. The sample size was 1260 individuals. About 75% of the people had 20 teeth or more present. Nine percent were edentulous. Seventy-seven percent who had demanded dental services during the last year. The average expenditure for dental treatment for those who had demanded the services during the last year was NOK 826. Fifty-three percent travelled 15 minutes or less from home to the dentist. Eighteen percent travelled 30 minutes or more. Almost everybody with their own teeth present brushed their teeth regularly once a day. Thirty-three percent of all dentate people used woodsticks regularly once a day, while 20% used toothfloss regularly. Seventy-five percent had no to mild fear of the dentist, while 7% had a strong fear. Fear of the dentist was higher among women than among men. Fear of the dentist decreased by increasing age. Few people, less than 4%, had cancelled a dental appointment because of dental anxiety. There has been an improvement in dental health and dental health behaviour in Norway during the 1970's and 1980's. These improvements are discussed with special attention paid to the findings from the present study.
The main objectives of this paper are to compare Aboriginal and Canadian health status and physician use and to identify the factors associated with the use of physician services. Data are drawn from the 1991 Aboriginal Peoples Survey (APS) and the 1991 General Social Survey (GSS), which are weighted random samples of the Aboriginal and total Canadian populations, respectively. The results demonstrate that Aboriginals were much less likely to use physician services, even though Aboriginals rank their health similarly to the total Canadian population. Location becomes an important aspect of both physician use and health status, with Aboriginals residing on-reserve generally having lower levels of self-assessed health and less likely to have seen a physician. While Aboriginals with the poorest health status were more likely to have seen a physician, other factors including education were found to be barriers to use of health care. Aboriginal identity and cultural orientation provided mixed results.
Birch and Abelson  argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed.
ABSTRACTOne of the keys to the success of the Canadian Longitudinal Study on Aging (CLSA) will be the leveraging of secondary data sources, particularly health care utilization (HCU) data. To examine the practical, methodological, and ethical aspects of accessing HCU data, one-on-one qualitative interviews were conducted with 53 data stewards and privacy commissioners/ombudsmen from across Canada. Study participants indicated that obtaining permission to access HCU data is generally possible; however, they noted that this will be a complex and lengthy process requiring considerable and meticulous preparatory work to ensure proper documentation and compliance with jurisdictional variations along legislative and policy lines.
The Indian Health Service (IHS) is unique among U.S. private and public health programs in that free comprehensive health services are provided to eligible American Indians and Alaska Natives regardless of their ability to pay. However, resource limitations may compel some eligible persons to go outside of the IHS system to receive health care. Although IHS eligibles have comparatively low rates of private or public health care coverage, and much of this population lives in underserved areas, over half of IHS-eligible persons had some type of out-of-plan use in 1987. Furthermore, services received through private providers appear to supplement those received through IHS-sponsored providers. Overall, persons who use both IHS and non-IHS providers have higher levels of health care use than do those who rely exclusively on the IHS.
Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.