The present study examined the impact of the Verterans Administration disability compensation system on the personality and behavior of psychiatrically disabled veterans who receive compensation payments. Weinstein proposed a "disability process" model in which physical illness or injury was unwittingly utilized as a solution to a network of problems centering on frustrated dependency needs, decreased productivity, and faltering self-esteem. An attempt was made to determine whether Weinstein's model applies to the psychiatric disabilities of veterans. Seventy-one male psychiatric outpatients seen at the Tucson Veterans Administration Medical Center participated in the study. Of this total, 26 had been receiving 100 percent service-connected compensation payments ($809 per month) for at least the past five years (100 percent group), 21 had been receiving between 10 percent and 90 percent payments ($44 to $450 per month) during the same period (10-90 percent group), and 24 had received no Veterans Administration compensation for their psychiatric impairments in the apst five years (UNC group). Personality questionnaires, a self-report demographics questionnaire, and a records search were utilized to compare these three groups. The main hypotheses contended that 10-90 percent group members weould be more self-critical and would view themselves as more psychologically disturbed and externally controlled than members of the other two groups, as they were assumed to be unconsciously fighting to establish the validity and extent of their disabilities. Subjects in the UNC group were hypothesized to be the healthiest psychologically because it was assumed that they had not become enmeshed int he "disability process". On 20 of the 21 subscales meauring some form of psychological distress, no significant differences among groups were uncovered. There were also no differences among groups on the internal-external locus of control dimension. These findings failed to support the hypothesis that the 10-90 percent group would see themselves as most psychologically disturbed and externally controlled. The expectation that 10-90 percent group members would be most self-critical was directly contradicted, as on three of ten subscales subjects in the 10-90 percent group reported significantly more positive self concepts than members of the other two groups. Despite the fact that they were rated for compensation purposes as "totally disabled," 100 percent group members reported no more psychological distress than subjects in the other two groups (with the exception that they reported significantly more hostility than UNC group members). However, both the attainment of inital 100 percent compensation status and of a permanent 100 percent rating led to significant reductions in the number of days 100 percent group members spent in the hospital (when the year after the rating change was compared with the year before). In addition, when they worked, subjects int he 100 percent group were employed in lower status occupations than members of the other two groups. UNC group members were shown to be similar to 100 percent group members on most assessment measures. However, during the past five years UNC group members were hospitalized significantly more times and for significantly more days than subjects in either of the other two groups. A direct discriminant function analysis generated two functions which together correctly classified 74.6 percent of the subjects. An unrotated factor analysis yielded factors descriptive of psychiatrically disabled veterans as a group. An alternative disability process model was proposed that may be more applicable to a psychiatrically impaired population. Also, future research projects were suggested including some possible experimental modifications in the Veterans Administration compensation system that might make it more beneficial to the mental health and self-esteem of psychiatrically impaired veterans, while maintaining cost efficiency.

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Faced with mounting health care costs, the United States needs to learn more cost-cutting options. The U.S. ranks at the top of lists on health care spending by country.1 The factors that drive American spending are complicated, and experts disagree with each other about which ones are most responsible for the country’s high medical costs; some commonly cited cost drivers include Medicaid, Medicare, fee-for-service and malpractice law. There are currently a number of methods employed by the government, hospitals, and insurance companies to keep costs down, including the increased use of Licensed Practical Nurses and Physicians Assistants, acute care and cost shifting,and Health Maintenance Organizations. In order to learn more about ways to save money on health care, the United States should look to other countries for examples. Switzerland enacted universal health care in 1994; in the nearly twenty years since, the government and insurance companies have instituted measures to control spending. These are practices and policies such as, blue letters of warning for seemingly frivolous doctors, no special insurance program or extra coverage for the elderly, and increased competition. Switzerland spends less on health care each year than the United States and yet has a higher life expectancy. 2 Furthermore, Switzerland celebrates twenty years of universal health care in the same year the individual mandate takes effect in the United States, 2014. Now is a timely moment to see if studying Switzerland’s health care system illuminates the options to American policymakers. Drawing information from scholarly articles, web articles, and website data, I will begin with a literature review section that underscores why a comparison between the Swiss and American health care systems can deepen our understanding of the policy options facing contemporary U.S. policymakers. I will then compare and contrast some specific features of the two health care systems. I will conclude by reflecting on whether and how lessons learned from Switzerland's health care policy can guide the American health care debate. / Department of Political Science

This study examined the experiences of United States America nurses caring for Mexican immigrant women; it focused on the language and cultural barriers that appear to be critical factors in delivering culturally appropriate healthcare. The questions that guided the research were: What adjustment issues .related to providing culturally appropriate healthcare to female Mexican patients do nurses have to face? What specific knowledge, skills can nurses learn to handle issues of cultural differences in patient care? Ten U.S. American nurses caring for Mexican immigrant women were interviewed; from these interviews, critical incidents were developed specific to caring for female Mexican women issues. Subsequently four bi-lingual bi-cultural Mexican women reviewed the incidents; their comments and incidents were incorporated into a cultural sensitizer to be used in future trainings of U.S. American nurses caring for Mexican immigrant women. My research shows that in attempting to make sense of ambiguous situations, U.S. American nurses tend to attribute the cause of Mexican immigrant women behavior through their own cultural filter. For this research, I identified salient intercultural concepts and skills that should be taught to U.S. American nurses caring for Mexican immigrant women. These intercultural skills, knowledge, and concepts are incorporated into the cultural sensitizer I designed and can be found in Chapter VI.

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / Vita. / Bibliography: leaves 134-138. / by Naomi A. Pless. / M.C.P.

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Using data from the Household Component of the 1996 Medical Expenditure Panel Survey, the study compares (1) the accessibility, and (2) the predictors of health care services utilization among African American and non-Hispanic White males, 18 to 65 years old in the United States. Using ANOVA procedure in comparing the means for use of physicians, hospitals, doctors, and difficulty obtaining care, seven hypotheses were tested in the study. First, it was hypothesized that African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and be more likely to report having experienced delay or difficulty obtaining care, compared to non-Hispanic white males of working age. Second, it was hypothesized that, controlling for health status, African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and will also be more likely to experience delay or difficulty obtaining care, than non-Hispanic white males. This was followed by the third hypothesis which compared utilization of physicians, hospitals, dentists, and difficulty obtaining care among African American and non-Hispanic white males, controlling for health status and insurance coverage (any insurance, private insurance, any public insurance, and Medicaid). Hypotheses four through six compared the utilization of physicians, hospitals, and dentists, as well as difficulty obtaining care among African American and non-Hispanic white males, controlling for the following variables sequentially: health status and poverty status; health status and having a usual source of care; and health status and employment status, in that order. Finally, it was hypothesized that, controlling for health status, any insurance, poverty status, and employment status, African American men of working age will have less access to physicians, hospitals, and dentists, and experience more difficulty and delay obtaining care, compared to non-Hispanic white males of working age. Results from the study indicated that Hypothesis 1 was supported for use of physicians and dentists. Hypotheses 2, 3a and 3c were supported for use of physicians, hospitals, and dentists. Hypotheses 3b, 3d, and 4 received support for use of physicians, hospitals, dentists, and difficulty obtaining care. Additionally, both Hypotheses 5 and 6 were supported for use of physicians, hospitals, and dentists, with the last hypothesis being confirmed for use of physicians, hospitals, dentists, and difficulty obtaining care. The study calls for a closure of the gap in access to health care between African American and non-Hispanic white adult males in the US. A reform-oriented government-sponsored single-payer plan modeled after the Canadian health care system is recommended for the United States. A national health insurance plan is most likely to ensure equity of access, compared to others, in the sense that it is founded on the premise that everyone will be covered in a similar fashion. Considering the role of Community Health Centers in serving Medicaid and Medicare recipients, low-income uninsured and insured, the underinsured, as well as high-risk populations and the elderly, in the interim, they should be extended to every community in the United States.

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A model for health care utilization was applied to a sample of low income women. Demographic Predisposing, Psychosocial Predisposing, Illness Level, and Enabling indicators were examined separately for African American (n = 266), Anglo American (n = 200), and Mexican American (n = 210) women. Structural Equation Modeling revealed that for African American and Anglo American women, Illness Level, the only significant path to Utilization, had a mediating effect on Psychosocial Predisposing indicators. The model for Mexican Americans was the most complex with Enabling indicators affecting Illness Level and Utilization. Psychosocial Predisposing indicators were mediated by Illness Level and Enabling indicators which both directly affected Utilization. Implications of the results for future research are addressed.