Some conjectures about access to US health care for disposed people

This paper hypothesizes the extent of access to health care by disposed people, particularly in the US. The disposed are people ‘thrown away’ as used‐up commodities. This paper briefly examines the theoretical idea of disposability. It then presents the basic results of new research showing that a sample of Americans sees that people in several different occupations are equally liable to be disposed. The section that follows proposes that the access these disposed people have to the US health‐care system is minimal overall and is not likely to improve. Because this total grouping has not previously been studied as a whole, these hypothetical findings are partly based on subsets of the disposed: the poor; those without health insurance; and the unemployed.     

Consumer use of the internet for health information: a survey of primary care patients

An increasing number of patients use the internet to obtain information about health. Although some information is available about how health professionals use the internet, little is known about how patients utilize this information. Some patients may actively seek information to assume more responsibility for their health. However, others may feel obliged to do so because of failing confidence in health care provision. Health professionals have the potential to assist patients to make sense of health information from the internet; however, they may not necessarily welcome this role. This study aims to evaluate patients’ use of such information in a primary care setting. The sample consisted of adult patients (n = 851) from two general practice populations at different levels of the socio‐economic spectrum in South Wales (UK). Patients were surveyed by questionnaire about the health information they use, including the internet. The majority of patients preferred to use their general practitioner as the main source of health information. The internet was jointly the second preferred source for information about an illness (6%). Just over half (51%) of patients in this study had access to the internet, of which about half use it to access health information. Just under a quarter (24%, n = 55) of health internet users had discussed information accessed from the internet during a subsequent consultation with a health professional. Of these, three‐quarters felt more prepared and able to participate in decision‐making about treatments. This study provides a greater understanding of how patients are making use of health‐related information from the internet. These findings can be used to help prepare health care professionals for dealing appropriately with internet‐informed patients.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Health Care Matters: Supply Chains In and Of the Health Sector

Providing health care involves a complex enterprise, and the trade‐off between quality and cost has been particularly stark compared to other industries. However, a recent focus on health sector supply networks is now producing significant innovations and improvements. This Special Topic Forum illustrates for the academic and practitioner community how health care supply chain research can benefit from our evolving understanding of supply chains and help push that understanding even further. We classify health care supply chain research into two broad categories—supply chain in health care and supply chain of health care—to set an agenda for future research.     

Healthier futures: primary care nurses’ food knowledge and patient advice

In Finland there are valid questions being asked about the sustainability of the current provision in state healthcare systems. Structurally, lower birth rates and greater longevity mean that populations age and present the challenge of chronic illness management in later life for a larger proportion of the population. Culturally, some 50 years after the introduction of a state healthcare system, ageing populations will have greater expectations of service quality than their predecessors. Paradoxically, they will also have a greater engagement with lifestyles which themselves will bring new challenges to long‐term health status. There is no single solution to the complex problem of service sustainability but undoubtedly health education provides some potential to limit future demands. Diet‐related illness and incapacity are specific health challenges for the coming decades but the problems can be substantially reduced by changing current behaviour. To make such changes possible, knowledge needs to be communicated effectively in terms of simplicity, accuracy and with appropriate timing. Health education can make a major contribution to service sustainability. This paper reports a study of primary care nurses (n = 50) in the Tampere area and examines their capacity to provide healthy eating advice. In this sample, nurses often demonstrated good levels of nutritional knowledge on which to base patient advice, but there was considerable variation. Arguably, focused in‐service training would provide updating on theory and practice for more consistent advice and better prospects for behavioural change.     

Estimating the effects of nutrition label use on Canadian consumer diet‐health concerns using propensity score matching

The overarching goal of nutrition labelling is to transform intrinsic credence attributes into searchable cues, which would enable consumers to make informed food choices at lower search costs. This study estimates the impact of nutrition label usage on Canadian consumers’ (n = 8,114) perceived diet‐health concerns using alternative propensity score matching (PSM) techniques. We apply a series of tests and sensitivity analyses to overcome issues of endogeneity and selection bias frequently found in studies of diet‐health behaviour and to validate the impact of exposure to nutrition facts labels for users vs. non‐users. Our results support the notion that consumer uncertainty and related food‐health concerns are linked to their information behaviour, but not in straightforward manner. Dominant subjective food attributes, such as taste, convenience and affordability, may in fact outweigh the benefits of information about healthier, alternative food choices. In order to change dietary health behaviour, food manufacturer and policy makers alike need to adopt communication instruments that better account for differences in preferences, shopping habits and overall usage patterns of nutrition labelling information.     

Why People Do Not Always Follow the Doctor's Orders: The Role of Hope and Perceived Control

The lack of adherence to medical advice is a widely recognized health care concern with important implications for consumer well‐being. This study advances a model for better understanding adherence behaviors by incorporating the positive emotion of hope and consumer perceptions of control. Empirical testing of the model in the context of type 2 diabetes, a lifestyle‐changing chronic illness, shows that hope generates more patient adherence. Furthermore, individuals have higher hope when they believe they are capable of performing the actions their treatment requires, and/or that their health outcomes are under their physician's control. The results indicate that health care providers can play an important role in encouraging adherence behaviors by cultivating hope and customizing their interactions with patients. Interventions aimed at increasing patient self‐efficacy or promoting patients' beliefs that health outcomes are under their physician's control are two routes to building hope. Health initiatives aimed at increasing diabetes treatment adherence should consider alternatives beyond asking patients to “take control” of their diabetes.     

Hope across the seas: the role of emotions and risk propensity in medical tourism advertising

Rising US medical costs as well as more competition in the health care industry have led many Americans to pursue health care in foreign destinations. As a result, leading countries in medical tourism have begun launching international advertising campaigns. A growing trend in much of this advertising is the use of emotional appeals. The purpose of this research is to examine whether the use of emotional appeals by non-domestic health care providers contributes to more favourable evaluations of the target health care provider than rational appeals. Specifically, two experimental studies investigate the efficacy of advertisements that induce the emotion of hope to determine whether these advertisements increase trust perceptions and reduce perceived risk, given an individual's level of risk propensity. Implications for public policy makers and marketing managers who work in health care are discussed.     

Neoliberalism and health care

Within the context of globalization, health care reform is occurring around the world. This paper explores the neoliberal mind set shaping health care reform in the UK, Canada, United States, Australia and New Zealand. Neoliberalism is comprised of three principles: individualism, free market via privatization and deregulation, and decentralization. After describing the nature of a health care system that is shaped by those embracing this mind set, an alternative approach is introduced that could bring dignity and a human face to health care. The basic premise of the paper is that we must broaden our analysis of health care by understanding and challenging the neoliberal mind set.     

An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.     

Balancing health,harmony and hegemony: Parents' goals and strategies in children's food related consumer socialization

Parents play a pivotal role in socializing their children for healthy eating. The objectives of the present study were (1) to identify food socialization outcomes valued by parents, and (2) to study how parents socialize their children for (healthy) eating at home and during food shopping. Including both parents' perceptions of valued food socialization outcomes and associated processes addresses a significant gap in the food socialization literature. The study used semi‐structured, in‐depth interviews with parents of young children. Data were subsequently analysed by interpretive, thematic procedures. The sample consisted of middle‐ to high‐income families from two cities in Denmark. Findings reveal four main food socialization goals valued by parents: (1) Nutrition and Health, (2) Healthy Relationship with Food, (3) Food Assimilation and (4) Self‐Regulation and Autonomy. Parents prioritized children's acquisition of a healthy relationship with food which included preserving family relations and harmony, more than strictly attending a nutritious diet, contrasting the focus on the nutritional value of diet usually emphasised by public health authorities. The study therefore concludes that parents' notions of what constitutes healthy diets for their children is not completely aligned with common nutrition‐oriented recommendations. Also, fathers were found to play a very active role in their children's food‐related consumer socialization. The findings underline the importance of addressing the priorities and strategies of both mothers and fathers when marketers and policy makers target contemporary families regarding children's food socialization.     

Process Coordination Within a Health Care Service Supply Network

There are two manifestations of supply chains in health care. One involves the supply of equipment and materials used in health care delivery. The other supply chain involves the delivery of health care itself, wherein patients supply their physical conditions and service suppliers deliver health care services. This article considers the latter supply chain, analyzing a case study in which patients have comorbidities and thus require the services of a network of multiple health care providers. In the case study, we examine three schemes for coordination of care. In the first scheme, the patient herself is expected to manage the coordination. In the second scheme, physicians are expected to coordinate the care. In the third scheme, a third‐party coordinator manages care across network members. We examine these three possible coordination alternatives using a technique known as Process‐Chain‐Network (PCN) Analysis. PCN Analysis helps us document how coordination schemes are implemented and where they may fail. Our analysis of the case study leads us to the development of ex post theory about who should initiate coordination and how it should take place under conditions of comorbidities. Empirical data coming from the case study support the theory. We describe possible applications of the theory inside and outside of health care, and show how the PCN approach can guide process innovation.     

The Era of the Functional Consumer

A discrete choice experiment was conducted to analyze consumer preferences for fruit and vegetable attributes in the context of the 2010 MyPlate Dietary Guidelines for Americans recommendations and to consider the role of health benefits and potential tradeoffs among fruit and vegetable quantity and quality attributes. Higher willingness to pay for fruit and vegetable attributes by the medium-high income respondents compared to low-income respondents may reflect the reality of a greater ability to pay. The magnitude of WTP toward satisfying MyPlate recommendations is substantially below the cost; therefore, it is not surprising that current consumption levels are well below the recommendation. Organic products had a stigmatizing effect for low-income respondents.     

Examining the Landscape of Managed Behavioral Health Care Through the Market Paradigm

ABSTRACT

The purpose of this article is to examine the market paradigm's impact on private practicing social workers, psychologists and psychiatrists who are reimbursed for services by managed behavioral health care organizations (MBHCOs). Five hundred eighty-two private practitioners from across the nation responded to a mailed survey in which they were asked a series of questions concerning changes in their business practices subsequent to joining MBHCO provider panels. Results indicate that despite the concerns about MBHC, these practitioners have sustained their practices. The market paradigm's use in explaining MBHC's impact on the private practitioners was found to have limited utility.     

Child–mother nutrition and health status in rural Kenya: the role of intra‐household resource allocation and education

There exists gender bias in resource ownership in many parts of Kenya with women being more disadvantaged. Resource ownership and control within the household has differential impacts on the health and overall well‐being of male and female members. This paper examines intra‐household resource ownership and how it affects nutrition and health status of household members. Data from a household survey containing detailed gender‐disaggregated information on resource ownership as well as food and anthropometry were collected from a rural Kenyan district and used in the analysis. Results showed that male members of the household had more access to education, income and land than the females. Mothers’ education, household income, frequency of illness and nutrient intake were the most important factors that contributed to the nutritional status of children. The education and household’s economic status were important determinants of child morbidity. Malnutrition and poor health of children and women is linked to the existing poverty in the study region, therefore emphasis needs to be put on eradication of discrimination against women in accessing education and accessing land, which will contribute to an increase in household incomes. Government policies need to focus on promotion of nutrition education through adult education programmes and incorporating it in the school curricula. Improvement of health‐care facilities in rural areas is also paramount to improving health and nutrition in these areas.     

An integrative model of customers' perceptions of health care services in Taiwan

As the health care service gets more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive the quality and value of their care before building up their satisfaction levels and generating behavioural intentions. Drawing some theories from marketing and health care service literature, this study tries to propose an integrative model of customers' perceptions of health care services based on the established relationship among four key constructs (service quality, perceived value, satisfaction, and behavioural intentions). Structural equation modelling is then used to validate the model. As Taiwan's universal health insurance offers every citizen equal financial access to all health care providers, Taiwan offers a good opportunity to study how the patients' perception model is structured. The findings reveal both perceived quality and value as antecedent variables in this model illustrating direct and indirect paths from perceived quality and value to patient satisfaction and behavioural intentions.     

Stereotype Processing's Effect on the Impact of the Myth/Fact Message Format and the Role of Personal Relevance

This research examines the effectiveness of the myth/fact message format (MFMF)—a message format that first presents a common misperception as a myth then counters it with a correcting fact—within the health‐care and social marketing context of mental illness (MI). Stereotype processing theory predicts that the use of a negative aspect of the stereotype in a MFMF may further instantiate the negative belief, thereby reducing the effectiveness of the message. Conversely, using a message format that conveys only facts (i.e., new positive beliefs) without inclusion of the myth will lead to more positive attitudes. However, this effect will only be seen among people with personal relevance with MI as only they are sufficiently motivated to suppress the automatically activated stereotype and elaborate on the message. A study demonstrates that advertising utilizing a fact‐only format leads to more positive attitudes than the MFMF among people with personal relevance while people without personal relevance to MI demonstrate no differences in attitude between myth/fact and fact‐only message formats. Personal relevance had the opposite moderating effect on perceived learning. These findings suggest that the MFMF's impact on attitudes, the typical focal point of social marketing campaigns targeting misconceptions about stereotyped groups, may be ineffective. Thus, using a fact‐only format that conveys new positive beliefs in a social marketing message is recommended within the specific context of MI and may be warranted in other health‐care and social issues.     

Development of functional food with the participation of the consumer. Motivators for consumption of functional products

The purpose of the study was (1) to define the most important characteristics of functional food affecting purchasing decisions; (2) diagnose the importance of the healthful properties of functional food; (3) identify preferences for carriers (base product) and the importance of the functional components essential in the choice of functional products; and (4) get to know the motives by which consumers are guided when purchasing functional food. The data were collected through direct interview (n = 200). The research tool was a questionnaire divided into four sections. The first one included quality attributes. The second one included healthful properties, functional components and carriers. The third one concerned the motives for purchasing functional food and included the consequences and values. In the fourth section the participants were asked about gender, age and education. The results of this study allowed determining the most important attributes of functional food products. Among quality attributes the most important are safe food, natural product and healthy product. The most important organoleptic attributes include nice taste. Very important attributes of packaging and labelling include expiry date and information on the healthful properties of the product. The most important healthful properties are associated with the attributes (1) strengthens the immune system; (2) reduces the risk of certain cancers; (3) reduces the risk of cardiovascular diseases; (4) helps maintain the correct body weight; (5) strengthens eyesight; (6) improves memory; and (7) improves physical condition. The functional components concern mainly vitamins and minerals, omega‐3 fatty acids and dietary fibre. As the best base products, consideration was given to bread, dairy products, cereal products, mixtures of fruits and vegetables and meat products. In the motivation system there were distinguished functional consequences that included improvement of health, needs of the organism, and healthy eating and psychological consequences such as conscious choice and health promotion. The most important autotelic values include good health and long life, health safety, inner harmony, self‐respect and self‐confidence. The means to achieve these goals are responsibility for health and care for health. The study provides bases for a better understanding of the consumer's needs and optimization of activities related to the development and consumption of functional food. The results of this study may provide valuable support for actions connected with the promotion and marketing of food products.