Americans seek a large amount of nonemergency care in emergency departments, where they often encounter long waits to be seen. Urgent centers and retail clinics have emerged as alternatives the department for care. We estimate that 13.7–27.1 percent all visits could take place at one these alternative sites, with potential cost savings approximately $4.4 billion annually. The primary conditions treated sites include minor acute illnesses, strains, fractures. There is some evidence patients...

This article focuses on racial and ethnic disparities in health care, describing both absolute differences relative changes access to care the use of services among whites, blacks, Hispanics over past two decades. Using data from a series three nationally representative medical expenditure surveys, authors present descriptive statistics between minorities whites time. They also multivariate analyses isolate extent which insurance income explain those disparities. The find that increased 1977...

This study explored reasons for racial and ethnic differences in children's usual sources of care.Data from the 1996 Medical Expenditure Panel Survey were examined by means logistic regression techniques.Black Hispanic children substantially less likely than White to have a source care. These persisted after control health insurance socioeconomic status. Control language ability, however, eliminated between children.Results suggest that marked disadvantage access care noted earlier studies...

Hispanic Americans are often treated as a monolithic ethnic group with single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use services and Americans'country ancestry or origin, language interview, length time lived in United States.Our data come from Medical Expenditure Panel Survey, nationally representative survey expenditures. Descriptive statistics logistic regression results...

In this article, we investigate the relationship between health behaviors, marital status, and gender in elderly population. We estimate logistic regression models to determine factors that affect likelihood of undertaking healthy behaviors. Using data from 1987 National Medical Expenditure Survey, find marriage has positive impacts on behaviors population that, when these effects differ by gender, they tend be larger for men than women. These results extend earlier findings showing...

This paper examines the extent to which cohabitation resembles marriage by comparing patterns of partner choice in formation married and cohabiting couples....On assumption that cohabitations are not informal marriages but relationships formed a looser bond we use exchange theory predict differences choice. Since less permanent than hypothesize choices give greater weight achieved characteristics (such as education) can reflect short-term ability contribute relationship. In turn expect...

Interview with Dr. Arthur Kellermann on the increasing use of emergency departments and access to primary care. (13:59)Download Many state governments are seeking ways cut Medicaid spending. Washington State has proposed reduce beneficiaries' overuse by refusing pay for "unnecessary" visits. However, care is often unavailable these patients.

Despite various policy initiatives, a substantial number of children in the United States remain uninsured, have problems with access to health care, or are fair poor health. These difficulties not evenly distributed across population. Hispanic children, those whose parents little education, and who live families without an employed parent at disproportionately high risk encountering these problems. Although multivariate analyses would be required disentangle complex relationships among...

Over the last decade, U.S. military forces have been engaged in extended conflicts that are characterized by increased operational tempo, most notably Iraq and Afghanistan. While personnel cope well across deployment cycle, many will experience difficulties handling stress at some point; face psychological health challenges, such as post-traumatic disorder or major depression; be affected short- long-term cognitive consequences of a traumatic brain injury (TBI). past several years,...

Despite persistent evidence of continued racial and ethnic disparities in health care, little explicit attention has been paid to how quality improvement activities might affect disparities. As the nation focuses on practical realities implementing care reform concurrent provisions under Affordable Care Act 2010, it is important recognize that overall improvements US system not automatically benefit all segments population equally. In this article we highlight challenges ensuring efforts...

Children with tracheotomy receive health care from an array of providers within various hospital and community system sectors. Previous studies have highlighted substandard information exchange between families these The aim this study was to investigate the perceptions experiences parents regard management, plan development coordination for children tracheotomy, strategies improve management children. Individual group interviews were performed eight fifteen healthcare (primary specialty...

Objective. To assess the extent to which racial/ethnic differences in ratings of patient experiences with health care represent true versus expectations, how scales are used, or identical physician–patient interactions perceived by members different groups. Study Setting. Primary data collection from a nationally representative online panel (n=567), including white, African American, and Latino respondents. Design. We administered questions on expectations care, series written vignettes,...

Objective To produce reliable and informative health plan performance data by race/ethnicity for the Medicare beneficiary population to consider appropriate presentation strategies. Data Sources Patient experience from 2008–2009 Advantage ( MA ) fee‐for‐service FFS CAHPS surveys HEDIS beneficiaries only). Study Design Mixed effects linear (and binomial) regression models estimated reliability statistical informativeness of measures. Principal Findings Seven seven measures were four...

The Centers for Medicare & Medicaid Services (CMS) have implemented Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys to assess patient experience in a number settings. Following CAHPS principles, RAND researchers designed field tested an Emergency Department Patient Experience Care Survey that consists three survey instruments use with adult patients who visited the emergency department (ED). One instrument is those are discharged community following their ED visit;...

Asian Americans (hereafter "Asians") generally report worse experiences with care than non-Latino whites "whites"), which may reflect differential use of response scales. Past studies indicate that Asians exhibit lower Extreme Response Tendency (ERT)-they less frequently responses at extreme ends the scale whites.To explore whether ERT is observed for in to standardized vignettes depicting patient and might part explain reporting whites.A representative US sample (n=575 Asian; n=505 white)...

Health maintenance organizations (HMOs) may relax some of the institutional barriers to using preventive screening services by requiring only a nominal copayment for such and promoting their use via educational programs. However, gatekeeper system employed HMOs discourage these if referrals are required access them. Using 1987 National Medical Expenditure Survey 1992 Interview Survey, authors investigate whether HMO enrollment is associated with nonelderly, privately insured women. Employing...

Reducing racial and ethnic disparities in the quality of health care is a national policy priority; collecting race ethnicity data from patients necessary first step identifying addressing these disparities. Recognizing this, Boston Massachusetts recently enacted collection regulations affecting all acute hospitals city state. This paper describes early lessons learned implementing efforts three areas: design tools, uses for eliminating disparities, role process such efforts.