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This chapter examines social variations in parent dissatisfaction with children’s medical care and tests whether greater dissatisfaction is associated with less preventive care and unmet medical need.

The 2007 National Survey of Children’s Health (NSCH) is a nationally representative cross-sectional sample of parents of U.S. children age 0–17 years (N=78,523). We use a combination of ordinary least squares (OLS) and binary logistic regression to analyze parent dissatisfaction, preventive care, and unmet medical need.

Our results indicate that parents’ dissatisfaction scores are significantly higher for racial/ethnic minorities, non-English speakers, lower socioeconomic status (SES) respondents, and the uninsured. Furthermore, parent dissatisfaction has a significant and robust association with lack of preventive care and reports of unmet medical need.

Due to the cross-sectional research design, we were unable to determine whether dissatisfaction caused parents to delay children’s medical care, thus resulting in a lack of annual preventive care and greater unmet needs.

Although there is extensive research on adult perceptions of their own medical care, few sociological studies have examined parents’ perceptions about their children’s care. Yet, there is substantial evidence that parents transmit health-related attitudes, beliefs, and behaviors to their children. As with adult patients, parent satisfaction with their child’s medical care is stratified by social characteristics; however, we also find a strong association between dissatisfaction and use of other important health services. It may be the case that when parents feel that they did not receive satisfactory care, they are more likely to delay, or to forgo, preventive and other health services.

Health care has become one of the paramount issues of the 21st century as governments and individuals grapple the complex problems associated with contemporary medical care such as cost, affordability, and shifting demographic trends. One response has been the growth of medical tourism (sometimes called health tourism or global healthcare). Medical tourism is an example of how the forces of globalization are re-shaping what has previously been a relatively stable localized service, medical treatment, in the face of changes to health care. While traveling to distant locations in search of health restoring locations is not new as the affluent have long traveled to spas or exotic locales to derive health benefits. What has changed is who is doing it and why they are doing it as insurers and patients alike become eager participants in the outsourcing of medical care. The rising number of uninsured and underinsured Americans, particularly in the middle class, has been coupled with effective marketing by medical tourism companies to produce growing numbers of Americans traveling to foreign countries for healthcare. China, India, Korea, Malaysia, the Philippines, South Africa, and Thailand are only a few of the competitors for overseas patients as a source for economic development. Using analytic frameworks of Immanuel Wallerstein and Anthony Giddens to provide a social analysis of this phenomenon yields an exploration of this trend.

To investigate ethnic group differences in the utilization of preventive medical care services among U.S. Asian and Latino immigrant adults.

Using data from the 2002–2003 National Latino and Asian American Study, we examined whether differences exist in the reporting of any preventive physical care or dental/optician visit during the last year across Asian and Latino immigrant groups. Following, we applied Andersen’s (1995) Behavioral Model of Health Services Use to assess how ethnic disparities in preventive care use are a function of predisposing, enabling/impeding, and need-based factors.

Descriptive results showed that among Latinos, a much lower proportion of Mexican immigrants reported a preventive medical care visit during the last year than either Cuban or Puerto Rican immigrants. Asian immigrants show less variation in use, but significant differences still exist with Filipino immigrants reporting the highest level of use, followed by Vietnamese and then Chinese immigrants. Logistic regression models also indicated that predisposing characteristics, especially aspects of acculturation status, contribute strongly to ethnic group differences in preventive care use, while enabling/disabling and need-based characteristics are less important.

While studies of medical care use often treat Asians and Latinos as homogeneous groups, our findings illustrate the need for a more detailed view of the foreign-born population. Findings also highlight the role of acculturation status in shaping group differences in preventive medical care use – and as such, the importance of considering these differences when promoting the use of timely preventive care services among immigrant populations.

In an effort to address health care disparities, U.S. laws mandate that health care organizations provide free language interpreting and translation anytime a patient and health care provider cannot communicate in the same language. The heretofore absence of legislative and professional oversight in health care interpreting allows for anyone to interpret. A qualitative study was conducted to understand the conditions and practices of bilingual staff who interpret as a secondary part of their job in community health clinics.

Four focus groups were conducted as part of a study on shared decision-making during interpreted medical visits in a busy, urban clinic serving a large number of limited English proficient (LEP) patients. The focus groups were designed to understand the process of interpreting and how interpreters influence medical decisions between LEP patients and their health care providers. To understand the interpreting process from multiple perspectives, one focus group was conducted with users of interpreters – monolingual health care providers (N=6), two with Spanish speaking men (N=10) who were experienced with interpreted health visits, and one with bilingual staff (N=5) who interpret as an ad hoc feature of their job, also known as dual-role medical interpreters.

Dual-role interpreters use different styles while interpreting what is communicated between health care providers and patients. In some cases, they provide near word-for-word interpretation of what is said. In other cases, they summarize and or paraphrase multiple sentences, seek clarity through questions, and deconstruct culturally laden and technical terms. In still other cases, dual-role interpreters combine interpretation styles within a single interactional exchange. Each of the three major styles of interpreting has advantages in medical settings. Specific style is influenced by health care provider preference, interpreter–health care provider trust and familiarity, and interpreter medical knowledge. Interpreters are challenged by the patients’ dialects, educational level, provider personalities, gender issues, and out of clinic relationships with the patients. Contextual conditions and contingencies of reinforcement contributed to varying methods of interpretation. These conditions included organizational policies, language and bilingual communication, and social relations with both the health care providers and the patients.

These findings demonstrate the complexity of medical interpretation and the critical involvement of health care providers and bilingual staff in facilitating interpreted encounters. Findings suggest the need for training both health care providers and interpreters and possible change in reimbursement for services.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

The level of mother’s health knowledge influences not only her health, but also significantly predicts her children’s health and medical care, and spending on medical care. This relationship has not yet been empirically assessed in India. The purpose of this paper is to measure the level of health knowledge of mothers in India and its association with the short-term illness in their children, medical care and medical care expenditure.

The authors used data from India Human Development Survey, 2004-2005. An index of “health knowledge” was constructed by using factor analysis. Multivariate binary logistic regression, multinomial logistic regression and multiple classification analysis were employed to analyze the relationship between mother’s health knowledge and child illness. Pearson’s χ2 test and ANOVA test were used to estimate levels of statistical significance in bivariate analyses.

The results revealed that children of mothers with medium and high-health knowledge were significantly less likely to have short-term illness (OR=0.390, p < 0.01 and OR=0.543, p < 0.01) than those children whose mothers had no or low-health knowledge (OR=1.00, p < 0.01) cutting across all background characteristics. Similarly, the attainment of modern medical care for short-term illness of children was nearly two times greater (OR=1.97, p < 0.05) in mothers with higher health knowledge as compared to mothers with no or low-health knowledge (OR=1.00, p < 0.01). The results also showed that mothers with higher health knowledge spent more on medical care for their children’s short-term illness than mothers with no and low-health knowledge.

The findings suggested a significant effect of mother’s health knowledge on the prevalence of short-term illness among their children, medical care and expenditure on the medical care. Appropriate health knowledge for women is crucial to the wellbeing of their children. Besides, social equity in terms of the distribution of facilities, to gain health knowledge and medical care, are essential to be established in India.

To the knowledge, this study is the first attempt to measure the health knowledge of women in reproductive age and its association with the prevalence of short-term illness, medical care and medical expenditure of their children in India. In general, a health knowledge index could be a significant composite predictor of the health in a population.

This study establishes a risk management system for medical and health care integration projects to address the problem of high-risk potential and a strong correlation between risk factors.

A new fuzzy WINGS-G1 model for identifying key risk factors in medical and health care integration projects is proposed by introducing the fuzzy theory and the concept of risk incidence into the Weighted Influence Non-linear Gauge System (WINGS) method.

The authors analyze the fluidity of project risk factors through complex networks to control direct risks and cut off risk transmission paths to provide a reference for risk control and prevention of medical and health care integration projects.

(1) The integration of fuzzy theory into the WINGS method solves the problem of strong subjectivity of expert scoring in the traditional WINGS method; (2) By the different probabilities of risk factors, the concept of risk incidence is introduced in the WINGS model, which is more conducive to the identification of the critical risk factors and the rational allocation and utilization of organizational resources; (3) The use of the complex network for risk interactivity analysis fully reflects the dynamic nature of risk factors in medical and health care integration projects.

This study aims to develop a framework for the management of medical records in support of health-care service delivery in the hospitals in the Limpopo province of South Africa.

The study was predominantly quantitative and has used the questionnaires, system analysis, document analysis and observation to collect data in 40 hospitals of Limpopo province. The sample of 49 per cent (306) records management officials were drawn out of 622 (100 per cent) total population. The response rate was 71 per cent (217) out of the entire sample.

The study discovered that a framework for management of medical records in the public hospitals is not in place because of several reasons and further demonstrates that public health-care institutions need an integrative framework for the proper management of medical records of all forms and in all media.

The study develops and suggests a framework to embed medical records management into the health-care service delivery workflow for effective records management and ease of access. It is hoped that such a framework will help hospitals in South Africa and elsewhere to improve their medical records management to support health-care service provision.

An analysis of community health, its history, successes and failures, depends on an understanding of its scope, but there is little consensus as to precisely what the discipline entails. Some view it as a strict scientific discipline, others see it as a social movement, and still others conceive of it as a conglomerate of various disciplines. It is useful initially to identify the medical components of community health, and then to approach its interdisciplinary aspects. Community health, strictly defined, includes such fields as disease control, environmental sanitation, maternal and child care, dental health, nutrition, school health, geriatrics, occupational health, and the treatment of drug and alcohol abuse. This limited definition, though accurate, does not differentiate the field from the much older area of public health. Within community health, the disease focus of traditional public health epidemiology, the total health focus of community medicine, and the outcome focus of health services research are interconnected. Community health combines the public health concern for health issues of defined populations with the preventive therapeutic approach of clinical medicine. An emphasis on personal health care is the result of this combination. Robert Kane describes the field accurately and succinctly: “We envision community medicine as a general organizational framework which draws upon a number of disciplines for its tools. In this sense, it is an applied discipline which adopts the knowledge and skills of other areas in its effort to solve community health problems. The tools described here include community diagnosis (which draws upon such diverse fields as sociology, political science, economics, biostatistics, and epidemiology), epidemiology itself, and health services research (the application of epidemiologic techniques on analyzing the effects of medical care on health).”

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non‐binding or so‐called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.