Objective. To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons.
Data Sources. The 1998–1999 Community Tracking Study household survey, administered primarily by telephone survey to households in 60 randomly selected communities, linked to data on community health centers, other free clinics, and safety net hospitals.
Study Design. Instrumental variable estimation of multivariate regression models of several measures of access to care (having a usual source of care, unmet or delayed medical care needs, ambulatory service use, and overnight hospital stays) against endogenous measures of distances to the nearest community health center and safety net hospital, controlling for characteristics of uninsured persons and other area characteristics that are related to access to care. The models are estimated with data from a nationally representative sample of uninsured people.
Principal Findings. Shorter distances to the nearest safety net providers increase access to care for uninsured persons. Failure to account for the endogeneity of distance to safety net providers on access to care generally leads to finding little or no safety net effects on access.
Conclusions. Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions.
The problem and the solution. Synthesizing findings from five selected case studies reflective of high-transitioning countries in the developing world, this article proposes a number of comparative discoveries about the necessary role and nature of national human resource development in this context. One such discovery is the influence of the political, economic, and sociocultural environments on the necessary nature and role of national human resource development in each country. A second is that context and intent shape and inform what makes for responsible human resource development. Another is that discoveries from this and other studies suggest emerging models and necessary attributes, components, and dimensions useful for informing an integrative and collaborative theoretical and sense-making framework for future study and practice of national human resource development. These and other discoveries pose numerous challenges to the human resource development profession—challenges that will require fundamental reperceiving by its professionals.
In this study, we tested the hypothesis that elite dinghy sailing is a whole-body, dynamic, repeated-effort sport, and that increased heart rate and oxygen consumption reflect its dynamic element. Six elite male Laser sailors (mean age 19.7 years, s = 1.82; height 1.81 m, s = 0.03; body mass 78.0 kg, s = 4.1) performed a cycle ergometer test to volitional exhaustion to determine peak oxygen uptake (VO(2peak)) and a simulated 30-min upwind leg sail on a specially constructed Laser sailing ergometer. The simulation protocol was based on video analysis of previous Laser World Championships. Expired gases were collected in Douglas bags, heart rate recorded at rest and after every 5 min, and pre- and post-simulation capillary blood samples taken for blood lactate analysis. Results were analysed with a one-way analysis of variance. Mean VO(2peak) was 4.32 l . min(-1) (s = 0.16). Mean simulation VO(2) was 2.51 l . min(-1) (s = 0.24) and peaked at 2.58 l . min(-1) (s = 0.25) during the 5th minute. Mean simulation heart rate was 156 beats . min(-1) (s = 8), peaking during the final minute at 160 beats . min(-1) (s = 10). These results suggest that, unlike pseudo-isometric static hiking, elite dinghy sailing demands a substantial proportion (58%VO(2peak), s = 5.6) of aerobic capacity.
Community home-based care (CHBC) is a critical component of non-formal care in communities in Africa that have a high prevalence of HIV and tuberculosis (TB). Community carers consisting primarily of volunteers are critical role players in African healthcare systems and particularly in South Africa's strategy to fight HIV and AIDS. This paper explores the structural barriers volunteer caregivers need to overcome to provide quality CHBC. The researchers used two focus group discussions with key informants (each with four participants), and semi-structured interviews with six key informants to collect data relating to the meaning of quality CHBC. The data were coded using Tesch's data analysis technique. A major theme that emerged from the results was "Addressing structural challenges to improve the quality of CHBC". Subthemes underpinning this theme were: 1) lack of standardised training of volunteer caregivers; 2) the need for a scope of practice, parameters and legal boundaries; 3) lack of monitoring and evaluation (M&E) of CHBC; and 4) the importance of mentoring and supervision in CHBC. CHBC policy should address the need for standardised training programmes for caregivers, so that they are equipped with multiple skills. Furthermore CHBC policy must emphasise mentoring as well as M&E to encourage quality care. Finally, the policy should provide a clear scope of practice for caregivers to regulate their competencies and boundaries.
Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectors of health care. Because of shared funding between the Commonwealth and States for ambulatory care, there has been intense focus on the ED patient population, and the potential to shift the locus of care for non-inpatients. One of the frequently cited models for the provision of after-hours GP services is the Balmain General Practice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinical quality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix of the patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has not been objectively established. Health service planning should recognise the distinct but complementary roles of general practice and emergency medicine. Evaluation of alternative models of service provision should critically examine the available evidence, and comparisons should be based on a precise analysis of equivalent services.
This study simulated whether increased community health center (CHC) funding under the Bush administration narrowed racial/ethnic gaps in access to care among low-income people. Expanded CHC funding resulted in small increases in access to care, more so for minorities than for whites. Spanish-speaking Hispanics had the largest improvements in access in the simulation. However, minorities experienced bigger drops in insurance coverage. The net result was no improvements in the access measures for Spanishspeaking Hispanics and slight decreases in access for whites, English-speaking Hispanics, and African Americans. Access gaps either remained the same or worsened slightly for English-speaking Hispanics and African Americans relative to whites. [Health Affairs 25,no. 6
The problem and the solution. South Africa as a developing country in the past decade has undergone a significant transformation in its national human resource development framework. Applying the holistic and integrative approach to human resource development of Harbison and Meyers, the social, political, and economic context of South Africa’s national human resource development is analyzed. The appropriateness of their approach is supported for the understanding of a transforming country’s national human resource development. It reinforces the contention that national human resource development must be understood in the context of a county’s historical roots, cultural values, education level, political system, and human resource development legislation in combination with its labor profile and economic system and policy.
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