Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 1998 Jun;33(2 Pt 2):402–423.

The emerging role of the client in the delivery of primary care to older Americans.

M A Counte 1
PMCID: PMC1070358  PMID: 9618677

Abstract

OBJECTIVE: To address the likely influences, on options faced by older clients, of specific changes in the delivery system and several possible responses to these changes and the changed options, by older persons in the aggregate. STUDY DESIGN: Four specific topics are discussed at length: (1) the probable altered role for the older healthcare client brought on by organizational changes; (2) findings from research on elderly health maintenance behavior and reasons for the increased importance of this issue; (3) the effectiveness of the conventional approach to explaining health services utilization in population studies; and (4) recommendations for future research into the direct or indirect influence of organizational changes in the primary healthcare system on the health-related decisions and behaviors of older persons.

Full text

PDF
402

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen R., Newman J. F. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973 Winter;51(1):95–124. [PubMed] [Google Scholar]
  2. Aristegui Fernández J., Cisterna Cáncer R., Muñiz Saitua J., Gorostiza E., Pérez Legorburu A., Cos Arregui B., Delgado Rubio A. Prevalencia de infección por el virus de la hepatitis B en instituciones de deficientes mentales. Características epidemiológicas en la provincia de Vizcaya. Med Clin (Barc) 1989 Mar 11;92(9):323–327. [PubMed] [Google Scholar]
  3. Bartling A. C. Trends in managed care. Healthc Exec. 1995 Mar-Apr;10(2):6–11. [PubMed] [Google Scholar]
  4. Brook R. H. Medicare quality and getting older: a personal essay. Health Aff (Millwood) 1995 Winter;14(4):73–81. doi: 10.1377/hlthaff.14.4.73. [DOI] [PubMed] [Google Scholar]
  5. Cella D. F. Quality of life: the concept. J Palliat Care. 1992 Autumn;8(3):8–13. [PubMed] [Google Scholar]
  6. Cella D. F., Tulsky D. S. Measuring quality of life today: methodological aspects. Oncology (Williston Park) 1990 May;4(5):29–69. [PubMed] [Google Scholar]
  7. Chulis G. S., Eppig F. P., Hogan M. O., Waldo D. R., Arnett R. H., 3rd Health insurance and the elderly. Health Aff (Millwood) 1993 Spring;12(1):111–118. doi: 10.1377/hlthaff.12.1.111. [DOI] [PubMed] [Google Scholar]
  8. Coile R. C., Jr Management teams for the 21st century. Healthc Exec. 1996 Jan-Feb;11(1):10–13. [PubMed] [Google Scholar]
  9. Counte M. A., Glandon G. L., Oleske D. M., Hill J. P. Total quality management in a health care organization: how are employees affected? Hosp Health Serv Adm. 1992 Winter;37(4):503–518. [PubMed] [Google Scholar]
  10. Davis K., Collins K. S., Schoen C., Morris C. Choice matters: enrollees' views of their health plans. Health Aff (Millwood) 1995 Summer;14(2):99–112. doi: 10.1377/hlthaff.14.2.99. [DOI] [PubMed] [Google Scholar]
  11. Flood A. B., Fennell M. L. Through the lenses of organizational sociology: the role of organizational theory and research in conceptualizing and examining our health care system. J Health Soc Behav. 1995;Spec No:154–169. [PubMed] [Google Scholar]
  12. Griffith J. R. Reengineering health care: management systems for survivors. Hosp Health Serv Adm. 1994 Winter;39(4):451–470. [PubMed] [Google Scholar]
  13. Hall J. A., Feldstein M., Fretwell M. D., Rowe J. W., Epstein A. M. Older patients' health status and satisfaction with medical care in an HMO population. Med Care. 1990 Mar;28(3):261–270. doi: 10.1097/00005650-199003000-00006. [DOI] [PubMed] [Google Scholar]
  14. Haug M. R., Wykle M. L., Namazi K. H. Self-care among older adults. Soc Sci Med. 1989;29(2):171–183. doi: 10.1016/0277-9536(89)90165-2. [DOI] [PubMed] [Google Scholar]
  15. Hickey T., Stilwell D. L. Health promotion for older people: all is not well. Gerontologist. 1991 Dec;31(6):822–829. doi: 10.1093/geront/31.6.822. [DOI] [PubMed] [Google Scholar]
  16. Jensen J., Counte M. A., Glandon G. L. Elderly health beliefs, attitudes, and maintenance. Prev Med. 1992 Jul;21(4):483–497. doi: 10.1016/0091-7435(92)90055-m. [DOI] [PubMed] [Google Scholar]
  17. Kasper J. D., Riley G. Satisfaction with medical care among elderly people in fee-for-service care and an HMO. J Aging Health. 1992 May;4(2):282–302. doi: 10.1177/089826439200400207. [DOI] [PubMed] [Google Scholar]
  18. Lynch J. W., Kaplan G. A., Shema S. J. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med. 1997 Dec 25;337(26):1889–1895. doi: 10.1056/NEJM199712253372606. [DOI] [PubMed] [Google Scholar]
  19. Manley M. J. The promise of integrated health care. Simple strategies for transforming organizations. Med Group Manage J. 1996 Jan-Feb;43(1):26-8, 30, 62. [PubMed] [Google Scholar]
  20. McCall N., Rice T., Boismier J., West R. Private health insurance and medical care utilization: evidence from the Medicare population. Inquiry. 1991 Fall;28(3):276–287. [PubMed] [Google Scholar]
  21. Miller R. H., Luft H. S. Managed care plan performance since 1980. A literature analysis. JAMA. 1994 May 18;271(19):1512–1519. [PubMed] [Google Scholar]
  22. Moon M., Davis K. Preserving and strengthening Medicare. Health Aff (Millwood) 1995 Winter;14(4):31–46. doi: 10.1377/hlthaff.14.4.31. [DOI] [PubMed] [Google Scholar]
  23. Pescosolido B. A., Kronenfeld J. J. Health, illness, and healing in an uncertain era: challenges from and for medical sociology. J Health Soc Behav. 1995;Spec No:5–33. [PubMed] [Google Scholar]
  24. Rice T. An economic assessment of health care coverage for the elderly. Milbank Q. 1987;65(4):488–520. [PubMed] [Google Scholar]
  25. Rossiter L. F., Langwell K., Wan T. T., Rivnyak M. Patient satisfaction among elderly enrollees and disenrollees in Medicare health maintenance organizations. Results from the National Medicare Competition Evaluation. JAMA. 1989 Jul 7;262(1):57–63. [PubMed] [Google Scholar]
  26. Rundall T. G. Health services for an aging society. Med Care Rev. 1992 Spring;49(1):3–18. doi: 10.1177/002570879204900102. [DOI] [PubMed] [Google Scholar]
  27. Schappert S. M. National Ambulatory Medical Care Survey: 1992 summary. Adv Data. 1994 Aug 18;(253):1–20. [PubMed] [Google Scholar]
  28. Scott W. R. The organization of medical care services: toward an integrated theoretical model. Med Care Rev. 1993 Fall;50(3):271–303. doi: 10.1177/002570879305000303. [DOI] [PubMed] [Google Scholar]
  29. Shortell S. M., Gillies R. R., Anderson D. A. The new world of managed care: creating organized delivery systems. Health Aff (Millwood) 1994 Winter;13(5):46–64. doi: 10.1377/hlthaff.13.5.46. [DOI] [PubMed] [Google Scholar]
  30. Shortell S. M., Levin D. Z., O'Brien J. L., Hughes E. F. Assessing the evidence on CQI: is the glass half empty or half full? Hosp Health Serv Adm. 1995 Spring;40(1):4–24. [PubMed] [Google Scholar]
  31. Shortell S. M., O'Brien J. L., Carman J. M., Foster R. W., Hughes E. F., Boerstler H., O'Connor E. J. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res. 1995 Jun;30(2):377–401. [PMC free article] [PubMed] [Google Scholar]
  32. Sofaer S., Davidson B. N., Goodman R. D., Grier R., Kenney E., Monk N., Ross A. Helping Medicare beneficiaries choose health insurance: the illness episode approach. Gerontologist. 1990 Jun;30(3):308–315. doi: 10.1093/geront/30.3.308. [DOI] [PubMed] [Google Scholar]
  33. Steinwachs D. M., Wu A. W., Skinner E. A. How will outcomes management work? Health Aff (Millwood) 1994 Fall;13(4):153–162. doi: 10.1377/hlthaff.13.4.153. [DOI] [PubMed] [Google Scholar]
  34. Stoller E. P., Forster L. E. Patterns of illness behavior among rural elderly: preliminary results of a health diary study. J Rural Health. 1992 Winter;8(1):13–26. doi: 10.1111/j.1748-0361.1992.tb00323.x. [DOI] [PubMed] [Google Scholar]
  35. Thomas C., Kelman H. R. Patterns of stability and change in health use among elderly people. Do service systems leave an imprint on behavior? J Aging Health. 1991 Feb;3(1):87–106. doi: 10.1177/089826439100300105. [DOI] [PubMed] [Google Scholar]
  36. Vachon M. L., Robinovitch A., Burklow J., Ganz P., Hermann J., Joseph R., Kane R. A. Cancer control and the older person. Psychosocial issues. Cancer. 1991 Dec 1;68(11 Suppl):2534–2539. doi: 10.1002/1097-0142(19911201)68:11+<2534::aid-cncr2820681511>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  37. Ward R. A. HMO satisfaction and understanding among recent Medicare enrollees. J Health Soc Behav. 1987 Dec;28(4):401–412. [PubMed] [Google Scholar]
  38. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  39. Wilcox-Gök V., Rubin J. Health insurance coverage among the elderly. Soc Sci Med. 1994 Jun;38(11):1521–1529. doi: 10.1016/0277-9536(94)90114-7. [DOI] [PubMed] [Google Scholar]
  40. Wolinsky F. D. Health services utilization among older adults: conceptual, measurement, and modeling issues in secondary analysis. Gerontologist. 1994 Aug;34(4):470–475. doi: 10.1093/geront/34.4.470. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES