Infertility Utilization and Women’s Self-Rated Health

Among women of reproductive age in the United States, at least 15 percent will report ever using infertility services. Using data from the 2006–2010 National Survey of Family Growth, this study considers the relationship between use of infertility services and a woman’s self-rated health. This study employs a logistic regression to predict the probability of reporting a certain level of self-rated health or lower when a woman reports seeking medical assistance for infertility. An additional measure considers the interaction between a woman ever using infertility services and the attitude toward having children on the probability of a lower level of self-rated health. Results indicate that ever using infertility services does increase the risk of women reporting worse self-rated health outcomes compared to women who have never used infertility services. The analysis of the interaction between the attitudes toward having children and ever using infertility services suggest that women who believe the reward of having children is worth the cost and who have ever used infertility services are also more likely to report worse self-rated health outcomes compared to women who have not used infertility services. This study provides further insight into the unique relationship between the infertility experience and overall health outcomes for women

The importance of examining movements within the US health care system: sequential logit modeling

Background: Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. Methods: The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage. Results: Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care. Conclusions: Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system

Health care policy : issues and trends/ Kronenfeld

203 hal.; 23 cm

The association between perceived provider discrimination, healthcare utilization and health status in racial and ethnic minorities.

Perceived provider discrimination contributes to health disparities in African Americans, Hispanics and Asians. Perceived provider discrimination has a direct effect on self-reported health status. Additionally, because minorities perceive more provider discrimination, they are more likely to delay health seeking. In turn, this delay is associated with poor health. This enriches our understanding of how racial/ethnic health disparities are created and sustained and provides a concrete mechanism on how to reduce health disparities

Panel Discussion: Social Justice: The Best Preventative Medicine

Tavora Buchman, PhD (Moderator) Director of Quality Improvement, Epidemiology and Research Director of Tuberculosis Control, Nassau County Department of Health David Fagan, MD Chairman, Department of Pediatrics Nassau University Medical Center Jennie Jacobs Kronenfeld, PhD Professor, Sociology Program, Sanford School of Social and Family Dynamics Arizona State University Erika Blacksher, PhD Assistant Professor, Department of Bioethics and Humanities University of Washington School of Medicine Jennifer Prah-Ruger, PhD, MSL Associate Professor, Department of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvani

The importance of examining movements within the US health care system: sequential logit modeling.

BackgroundUtilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.MethodsThe sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage.ResultsGender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care.ConclusionsUse of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system