RESUMEN
Low-income women have a high mortality from breast cancer. Yet, they participate in breast cancer early detection screening programs less than women in the general population. An intervention study to improve screening mammography rates of low-income women participating in Tennessee's TennCare program (state Medicaid and Medicare program) revealed significant barriers to reaching these women. Intervention methods included mail, telephone calls, and home visits. Results indicate that only 38 percent of the women could be contacted for a baseline survey. Reasons for noncontact included absence from home (39 percent), having moved (22 percent), refusal to participate (17 percent), having no physical domicile (15 percent), language barriers (4 percent), and miscellaneous other factors (4 percent). Women with telephones tended to have a relatively higher economic status and were more successfully reached than women without telephones. These findings provide useful insights for future program planning and research design.
Asunto(s)
Relaciones Comunidad-Institución , Educación en Salud/métodos , Mamografía/psicología , Tamizaje Masivo/psicología , Aceptación de la Atención de Salud/psicología , Selección de Paciente , Pobreza/psicología , Mujeres/psicología , Adulto , Femenino , Humanos , Mamografía/estadística & datos numéricos , Programas Controlados de Atención en Salud/organización & administración , Tamizaje Masivo/estadística & datos numéricos , Medicaid , Medicare , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Teléfono , Tennessee , Estados Unidos , Mujeres/educaciónRESUMEN
The United States is the only developed country with no national health care policy. What exists is a national health insurance system. The problem with this system arises when paying for health care for the poor, who often require the most expensive type of care for acute or episodic ailments. Managed care, though not a panacea, has the potential of providing the organization to effectively control costs and change the existing health care paradigm from one of fee-for-service inpatient care to one of ambulatory care, home-based care, and physician office-based procedures. An example of a state-based initiative that has cut medical costs is Tennessee's TennCare. Under TennCare, approximately 1.2 million Tennesseans are covered, nearly 400,000 of whom were previously uninsured. Such programs, both state and national, must now look to including prevention and wellness care to effectively change the underlying epidemiology of illness among the poor.
Asunto(s)
Programas Controlados de Atención en Salud/organización & administración , Medicaid/organización & administración , Planes Estatales de Salud/organización & administración , Adolescente , Negro o Afroamericano , Niño , Protección a la Infancia , Preescolar , Femenino , Costos de la Atención en Salud , Humanos , Lactante , Recién Nacido , Pacientes no Asegurados , Planes Estatales de Salud/economía , Tennessee , Estados UnidosRESUMEN
In 1994, it was estimated that about 44,500 American women would die from breast cancer and 7000 women from cervical cancer. While early detection methods (screening mammography, breast examinations, and pap smears) have proven to be effective means of decreasing these cancers, they are underused by all groups. In particular, low-income women use them least, resulting in their lower survival and higher mortality rates than the rest of the population. This article quantifies the effect of a simple intervention undertaken by a health maintenance organization (HMO) serving the indigent to improve breast and cervical cancer screening rates. The HMO mailed personal letters and newsletter articles to women members > or = 40 years about the need for cancer prevention. Articles also were printed in the monthly HMO newsletters to providers about the benefits of using these early detection methods. A review of provider claims from 574 women showed that baseline utilization rates for screening mammograms and pap smears before the intervention in year 1 (1990) were 14% and 16.4%, respectively. After the intervention, in years 2 and 3, mammograms had increased to 41% and pap smears to 38% for both years, indicating a levelling off effect of the intervention by year 3. These data show that while a significant improvement in screening behaviors was achieved, the intervention impact was limited to only about one third of the sample on the long term. Further, data do not indicate whether behavioral change was initiated as the member or provider level. More research is needed to increase overall screening behavior among the indigent and their physicians. The results reported here provide a baseline against which more intensive interventions can be measured in this setting.
Asunto(s)
Neoplasias de la Mama/prevención & control , Promoción de la Salud/métodos , Pobreza , Neoplasias del Cuello Uterino/prevención & control , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Prueba de Papanicolaou , Tennessee , Frotis Vaginal/estadística & datos numéricosRESUMEN
Successful managed care requires two-way responsibility. Providers must design health plans that market services intelligently, communicate with enrolled clients effectively, solicit frequent feedback from consumers, and are genuinely responsive to the needs of patients. Consumers are responsible for demonstrating self-care, consuming medical resources wisely, and exercising personal initiative to help make managed care work.
Asunto(s)
Participación de la Comunidad , Programas Controlados de Atención en Salud/normas , Comercialización de los Servicios de Salud/normas , Reforma de la Atención de Salud , Humanos , Programas Controlados de Atención en Salud/economía , TennesseeRESUMEN
One point which has emerged with a resounding voice during this conference is the need to clearly assemble and carefully communicate data and information as a means of empowerment. We hope that the recommendations from this conference will contribute to this end. We urge all to become actively involved in seeking change, and ensuring that the future health of Americans and of our nation will not reflect our inequitable, costly present.