We studied 458 consecutive patient transfers from 14 ty studied, transfer is a common and potentially dangerous medical private hospitals to a public hospital emergency room during a sixintervention which appears to reinforce racial and class inequalities month period. The transferred patients were predominantly male, of access to medical care. (Am J Public Health 1984; 74:494-497.) young, and uninsured, and included large numbers of minority group members. We established criteria to identify patients at high risk for adverse effects of transfer and reviewed the clinical records of the 103 patients meeting these criteria. We judged that transfer resulted Introduction in substandard care for 33 of these patients, either because theyLittle is known about the transfer of patients between were at risk for life-threatening complications in transit or because hospital emergency rooms. Anecdotal reports suggest that such transfers are common, may be hazardous, and dispro- Of the 458 patients transferred to the emergency department, 272 (53 per cent) were admitted to the hospital, 22 of whom required intensive care. Thirty-two patients (7 per cent) were referred to the Department of Psychiatry, 9 (2 per cent) were taken into custody by judicial authorities, and 27 (6 per cent) were transferred to other institutions for further care. The study population of 458 patients with 272 admissions represented 2 per cent of emergency room visits and 6.5 per cent of all hospital admissions at Highland General.Half of the patients had suffered traumatic injuries; 8 per cent were thought to have taken drug overdoses; and 5 per cent had alcohol withdrawal syndromes.Each of the 14 private hospitals in Alameda County with an emergency room transferred at least 11 patients to the county hospital. The 12 private hospitals with full emergency services were responsible for 91 per cent of the transfers, with four of these accounting for 55 per cent of all transfers. Sixty-six per cent of patients were transported by ambulance, and the remaining 34 per cent provided their own transportation.Seventy-nine (31 per cent) of the White patients transferred were insured, while 90 (44 per cent) of the non-White patients had health insurance (Chi square df 1 = 7.5, p<.01). Clinical EvaluationOf the 103 patients whose charts were reviewed, only one patient was explicitly transferred for a medical indication, a service not available at the original hospital. In 11 cases, physicians indicated that the patient was transferred because of inability to pay. In no case did a physician or nurse accompany the patient during transfer.In 33 cases (24 males and 9 females), transfer was judged to have jeopardized the patient. Fourteen (42 per cent) of those jeopardized were non-Spanish surnamed Whites, while this group accounted for 56 per cent of nonjeopardized transfers (Chi square df 1 = 2.35, p=.12). Twenty-eight (85 per cent) of those imperiled by transfer were uninsured, a significantly greater proportion than the 62 per cent uninsured among tho...
We analyzed deaths of blacks and whites in Alameda County, California where previous studies have documented consistent racial inequalities in health services. We classified each death during 1978 as due to preventable and manageable conditions or as "non-preventable" according to lists compiled by the Working Group on Preventable and Manageable Diseases chaired by Dr. David Rutstein. The total death rate for blacks 0-65 years of age exceeded that of whites by 58 percent (p less than .01). Rates of death due to preventable and manageable conditions for persons aged 0-65 years were 77 percent higher for blacks than for whites (p less than .01). More than one-third of the excess total death rate of blacks relative to whites could be explained by the excess of potentially preventable deaths. Our findings suggest that inequalities in health services reinforce broader social inequalities and are in part responsible for disparities in health status. Improvements in the health and longevity of blacks and other oppressed groups might be achieved by improved access to existing medical, public health, and other preventive measures.
Government support of public and private hospitals in Oakland and Berkeley, California was investigated. The private hospitals received government subsidies amounting to at least 60 per cent of their total revenues. The dollar amount of the subsidies to private hospitals was four and one-half times greater than government expenditures on the public hospital. In Oakland and Berkeley, as in many cities, public medical services have been reduced while both government health expenditures and private hospital revenues have increased sharply. The private hospitals, although all nominally non-profit, exhibit revenue maximizing behavior which results in socially unjust and medically irrational resource allocation. Funds might be found for public hospitals and clinics, and resources allocated more justly and rationally, if government expenditures in the private sector were brought under greater public scrutiny and control.
The decline in birthrates in the developed countries of the world has forced multinational corporations engaged in the production of infant formula to seek out new markets in the developing countries, where burgeoning population rates potentially guarantee the long-term profitability of these corporations. This development, ostensibly benign and nutritionally advantageous to infants in developing countries, has serious public health consequences, due to the high relative cost of purchased formula and the paucity of hygienic facilities essential to the sterile preparation of bottle formula. This paper delineates in detail economic and contraceptive advantages of breast-feeding, and examines the role of health personnel and multinational advertising techniques which have catalyzed the decline in breast-feeding. In addition, the paper focuses on the question of cultural imperialism and current efforts to regulate the multinational firms through both United Nations groups and stock-holders' suits. Finally, some suggestions are made concerning ameliorative public policy approaches to the breast-feeding controversy.
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