Browsing by keyword "Personal Health Services"
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Dimensions of patient attitudes regarding doctors and medical care servicesThe factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and ease of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.
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Effects of cost sharing on seeking care for serious and minor symptoms. Results of a randomized controlled trialTo estimate the effect of cost sharing on seeking care for serious and minor symptoms, we analyzed data for 3539 persons aged 17 to 61 from the Rand Health Insurance Experiment. Participants were randomly assigned to a free-care group or to insurance plans requiring them to pay part of the costs (cost-sharing group). Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician. Serious symptoms were judged by a panel of physicians to warrant care in most instances; minor symptoms were judged neither to be severe nor to warrant care in most instances. The cost-sharing group was nearly one third less likely than the free-care group to see a physician when they had minor symptoms (6.3% compared with 9.0%; p less than 0.04). The free-care and cost-sharing groups did not differ significantly in seeking care for serious symptoms (22.3% compared with 17.9%; p = 0.095). However, for participants with low socioeconomic status who began the study in poor health, the prevalence of serious symptoms was higher in the cost-sharing than the free-care group (29.1% compared with 23.8%, p less than 0.004).