Dissertation (D.P.H.)--University of Michigan.

This thesis is based on a study conducted for the state of Oregon's Office of Mental Health Services (OMHS). OMHS' primary research objectives included 1) the identification of the unfunded population (individuals who are uninsured and ineligible for Medicaid) who seek services at community mental health programs and 2) an examination of this group's access to atypical antipsychotic and antidepressant medications. OMHS sought this data in order to inform legislative decisions regarding a forthcoming state budget proposal for a specialized atypicals fund. The author collected ethnographic data through semi-structured interviews with 57 mental health clinicians and 41 mental health advocates throughout Multnomah, Linn and Lincoln counties. While answers to the primary research objectives were inconclusive, the qualitative data characterizes the target population and contextualizes the unfunded client's medication access issues at county-related mental health clinics. Specifically, the study results indicate that 1) the complex characteristics of the unfunded population and the inadequacies of the available medication resource programs should be examined more thoroughly before allocating appropriated funds, 2) insufficient mental health services in general is the foremost problem for unfunded clients, and that which contributes to difficulties in accessing psychotropic medications, and 3) appropriated funds from the state's budget would not adequately resolve the medication needs for the target population. The study findings suggest that the state's concern with atypical medications overshadows existing practical, everyday problems in the clinics. The author analyzes the study from a Critical Medical Anthropology perspective, examining the relationships between the global and local contexts surrounding atypical medications, and discussing the practical use of the research data. From this perspective, the state's preoccupation with supplying atypical medications for the target population appears to be driven more by the pharmaceutical industry's profit-making interests and the historical role of the public psychiatric field than by quality health care decisions. The author also discusses medical hegemony in terms of the psychiatric field, and the ways in which this effects the asymmetrical power within the Oregon mental health system. / Graduation date: 2000

No description available.

The objective of this research was to determine if healthcare access disparities exist across race and gender in a publically funded safety-net healthcare system in Texas. Data were examined from a representative random sample of 1468 adults aged 18-64 who were patients in this safety-net system in July and August of 2000 and were analyzed using binary logistic regression and chi-square measures of significance. Major Findings: On measures of health status - overall health rating (p =.051), limited employment (p =.000), energy level (p =.001), and worry (p =.012) - Anglos reported the worst health; Mexican Americans, the best health; with African Americans intermediate. Mexican Americans were more likely to have never had health insurance, and to also have had insurance in the past year; Anglos were least likely to have ever had insurance (p =.015) or to have had insurance in the past year (p =.000). On use of EDs (p =.028), problems getting prescription medicines (p =.029), and foregoing other necessities of life to pay for healthcare, Mexican Americans were least disadvantaged with African Americans reporting greatest use of EDs among both men and women, and Anglos the most problems with prescription medicines and foregoing care, especially among women. Logistic regression revealed that health status was the strongest predictor of problems accessing healthcare in all groups; the poorer health status of safety-net patients, the more problems they had accessing care. Patterns of poor reported health status and greater problems accessing care among Anglos relative to other groups is discussed in terms of social drift and relative deprivation.

Objectif : Des recherches antérieures ont identifié une mauvaise utilisation des soins prénataux chez les migrants sans assurance maladie au Canada. Cependant, les facteurs qui influencent cette utilisation restent largement inexplorés. L'objectif de cette étude était de quantifier l'utilisation des soins prénataux dans ce groupe et d'identifier les barrières et les facteurs facilitant l'utilisation des soins prénataux. Méthodes : Une étude transversale sur les migrants sans assurance maladie à Montréal, Canada, a été menée entre janvier 2016 et août 2017. Les participants ont été recrutés dans une clinique bénévole locale et dans la communauté en utilisant un échantillonnage à partir de lieux et en boule de neige. Les mesures des résultats comprenaient l'utilisation des soins prénataux, l'initiation des soins prénataux et l'adéquation des soins prénataux. L'analyse de régression a identifié les barrières et les facteurs facilitant l'utilisation des soins prénataux. Résultats : 125 grossesses antérieures au Canada ont été recensées parmi 101 femmes. 65.0% des grossesses impliquaient une utilisation des soins prénataux et 44.6% impliquaient un début tôt des soins. Parmi les 62 grossesses menées à terme, 29.5% ont reçu des soins prénataux adéquats. Les femmes ≥35 ans (OR 0.13, IC à 95%: 0.03-0.54, p = 0.01), entre 18 et 24 ans (OR 0.30, IC à 95%: 0.09-0.99, p=0.049), et celles qui ne savaient pas où consulter (OR 0.25, IC à 95%: 0.06-0.99, p=0.049) avaient significativement moins de chances (p <0.05) d’utiliser les soins prénataux. Les femmes âgées de 30 à 34 ans (OR 0.27, IC à 95%: 0.10-0.72, p=0.01) avaient significativement moins de chances (p <0.05) de commencer tôt les soins prénataux. En revanche, les femmes mariées ou en union de fait (OR 3.16, IC à 95%: 1.04-9.62, p=0.04) avaient significativement plus de chances (p <0.05) de commencer tôt les soins prénataux. Conclusion : Notre étude a révélé que l'utilisation des soins prénataux chez les migrants sans assurance était très faible. Les facteurs influençant l'utilisation des soins prénatals étaient variés et liés à la démographie, au réseau social et à la migration. Les politiques futures devraient viser à améliorer l'accès aux soins prénatals au sein de cette population vulnérable. / Objective: Previous research has identified poor prenatal care use among uninsured migrants in Canada, however, the factors influencing this usage remain largely unexplored. The study objective was to quantify the use of prenatal care among this group and to identify the barriers and facilitating factors to prenatal care use. Methods: A cross-sectional survey of uninsured migrants in Montreal, Canada was carried out between January 2016 and August 2017. Participants were recruited from a local volunteer clinic and from the community using venue-based and snowball sampling. Outcome measures included prenatal care use, prenatal care initiation, and prenatal care adequacy. Regression analysis identified barriers and facilitating factors to prenatal care use. Results: 125 previous pregnancies in Canada were identified among 101 women. 65.0% of pregnancies involved prenatal care use and 44.6% involved an early initiation of care. Among the 62 pregnancies carried to term, 29.5% received adequate prenatal care. Women ≥35 years of age (OR 0.13, 95% CI: 0.03-0.54, p=0.01), between the ages of 18-24 (OR 0.30, 95% CI: 0.09-0.99, p=0.049), and those who did not know where to consult (OR 0.25, 95% CI: 0.06-0.99, p=0.049) were significantly less likely (p<0.05) to use prenatal care. Women aged 30-34 (OR 0.27, 95% CI: 0.10-0.72, p=0.01) were significantly less likely (p<0.05) to initiate prenatal care early. In contrast, women who were married or in common-law relationships (OR 3.16, 95% CI: 1.04-9.62, p=0.04) were significantly more likely (p<0.05) to initiate prenatal care early. Conclusion: Our study found that prenatal care use among uninsured migrants was very poor. Factors influencing prenatal care use were varied and related to demographics, social network, and migration. Future policy should aim to improve access to prenatal care among this vulnerable population.