Accesibilidad urbana a la atención médica primaria: estudio comparativo de Canadá, EE.UU. y de Chile

The question of accessibility to primary medical care is examined for three medical systems; the large private market in the United States and the predominantly state-financed systems in Canada and Chile. Major health policies in these countries are reviewed and the spatial patterns of primary care physicians and centers are described. Comparative findings reveal that private physicians'preference for locating in pleasant residential settings in both Canada and Santiago, Chile is an indication that the more state-financed medical systems tend to be weaker agents of disperion than the free-market structure of the U.S. Unlike Canada and Chile, the locational attributes of primary care practitioners in the U.S. are their proximity to suburban retail districts and major thoroughfares of automobile travel

Accesibilidad urbana a la atención médica primaria: estudio comparativo de Canadá, EE.UU. y de Chile

The question of accessibility to primary medical care is examined for three medical systems; the large private market in the United States and the predominantly state-financed systems in Canada and Chile. Major health policies in these countries are reviewed and the spatial patterns of primary care physicians and centers are described. Comparative findings reveal that private physicians'preference for locating in pleasant residential settings in both Canada and Santiago, Chile is an indication that the more state-financed medical systems tend to be weaker agents of disperion than the free-market structure of the U.S. Unlike Canada and Chile, the locational attributes of primary care practitioners in the U.S. are their proximity to suburban retail districts and major thoroughfares of automobile travel

DRG calculation and utilization patterns: A review of method and policy

This paper examines methodological and policy issues of interest to medical geographers who use diagnosis-related groups (DRGs) in their research. Methodological issues are studied in terms of the calculation of DRGs and variation in the utilization of surgical and medical DRGs. It is argued that a shift to a single DRG price system should first address the (i) regional disparties that currently exist and the need for large-scale indices of medical wages and labor costs; (ii) severity of illness measurements other than the present nominal ones; and (iii) wide variation among medical versus surgical procedures. The Department of Commerce's Economic Analysis Area is recommended to remedy the problem of geographic scale. Policy issues of interest to medical geographers center around the shift to greater hospital specialization which is likely to continue across the country. Inner-city, rural and teaching hospitals may continue to be inadequately reimbursed by DRGs, treat more medically indigent, or both. Medical geographers should be aware of the policy and methodological issues not only in DRGs, but in proposed prospective payment systems for ambulatory and long-term care.DRGs prospective payment systems (PPS) Medicare regions geographic scale teaching hospitals