Abstract：
:Many health care professionals have sustained an almost single-minded conviction that disparities in access to health care across socioeconomic groups are the key reason for the major discrepancies in health status between wealthy persons and poor persons. Others, however, have argued that a host of factors work to create major impediments and that reducing or eliminating financial barriers to health care in particular will do little to reduce discrepancies in health status. This paper, while acknowledging the spectrum of contributing factors, argues that the elimination of financially based differences in access is central to any effort to create equity in outcomes across socioeconomic groups. Through selected review of the many studies on health insurance, access, outcomes, and socioeconomic status, it establishes that a core links affected populations, their difficulty in financing health care, and the threat to their well-being. In so doing, it cites findings that strongly associate lack of insurance (especially for persons who live in poverty), inability to obtain services, and adverse health outcomes. It also uses the example of Medicaid and other coverage for HIV-infected persons in particular as an important positive instance in which leveling the discrepancies in health care across socioeconomic groups can move toward creating quality in access and outcomes. The competitive pressures in today's health care environment threaten to drive socioeconomic groups further apart, especially insured and uninsured persons. However, the recent enactment of state actions, especially the State Child Health Insurance Program, represent powerful examples of health insurance expansion that have lessons for policymakers at all levels for the monitoring and reduction of socioeconomic disparities.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Andrulis DPdoi
10.7326/0003-4819-129-5-199809010-00012subject
Has Abstractpub_date
1998-09-01 00:00:00pages
412-6issue
5eissn
0003-4819issn
1539-3704journal_volume
129pub_type
杂志文章,评审abstract：:Forceful new demands for accountability in medicine are arising from many interested parties. To maintain professional standards, physicians need to establish which demands are desirable and which are not. We adopt a model of stratified accountability that includes three major components: the accountable parties, the ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-124-2-199601150-00008
更新日期：1996-01-15 00:00:00
abstract：:The relationship between oral contraceptives and death from thromboembolism shown by studies of vital statistics, and the contribution of cigarette smoking to these deaths are reviewed. In 1968 a British study showed that a slight increase in deaths from thromboembolism had occurred in young women, proportional to th...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：
更新日期：1970-09-01 00:00:00
abstract：BACKGROUND:Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include women 40 to 49 years of age remains controversial. OBJECTIVE:To compare the cost-effectiveness of screening mammography in wom...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-127-11-199712010-00001
更新日期：1997-12-01 00:00:00
abstract：OBJECTIVE:To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomograph...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-123-8-199510150-00005
更新日期：1995-10-15 00:00:00
abstract：PURPOSE:To review current management of intractable constipation. DATA SOURCES:Original articles and reviews published in the English-language literature between 1965 and 1993 identified by MEDLINE search. Verbal feedback from attendees after presentation of the document as a clinical symposium at the 14th Internation...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-121-7-199410010-00008
更新日期：1994-10-01 00:00:00
abstract：:Kidney transplantation is safe, cost-effective, and beneficial for patients with end-stage renal disease. The number of patients who can receive transplants is severely limited by the availability of donor organs. Because most patients do not have a suitable living, related donor, transplant programs now rely on the u...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-98-4-536
更新日期：1983-04-01 00:00:00
abstract：:Active-control noninferiority trials are being performed with increasing frequency when standard placebo-controlled trials are considered unethical. Three attributes are optimally required to establish noninferiority: 1) The treatment under consideration exhibits therapeutic noninferiority to the active control; 2) th...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-145-1-200607040-00011
更新日期：2006-07-04 00:00:00
abstract：:Cost-effectiveness analysis and other forms of decision analysis are becoming more common in the medical literature and are increasingly influential in the development of health policy. Nevertheless, many clinicians find it difficult to apply policies developed from these analyses to individual encounters with patient...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-122-11-199506010-00007
更新日期：1995-06-01 00:00:00
abstract：STUDY OBJECTIVE:To determine the clinical variables affecting outcome after balloon aortic valvuloplasty. DESIGN:Longitudinal follow-up of consecutive case series. PATIENTS:Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus. INTERVE...
journal_title：Annals of internal medicine
pub_type： 临床试验,杂志文章
doi：10.7326/0003-4819-110-6-421
更新日期：1989-03-15 00:00:00
abstract：:Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities d...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-146-9-200705010-00155
更新日期：2007-05-01 00:00:00
abstract：Background:The presence of extracranial carotid disease (ECD) is associated with less favorable clinical outcomes in patients with acute ischemic stroke caused by intracranial proximal occlusion. Acute intra-arterial treatment (IAT) in the setting of extracranial and intracranial lesions is considered challenging, and ...
journal_title：Annals of internal medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.7326/M16-1536
更新日期：2017-06-20 00:00:00
abstract：:Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, bu...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-128-6-199803150-00007
更新日期：1998-03-15 00:00:00
abstract：:In 1984, both the United Kingdom and the United States received recommendations from panels of experts specifically convened to consider the merits of Depo-Provera (depot medroxyprogesterone acetate [DMPA]) as a long-term contraceptive agent. This study compares the final reports written by these panels. We explore wh...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-106-6-886
更新日期：1987-06-01 00:00:00
abstract：:A controlled clinical trial compared three-drug and four-drug combination chemotherapy in 109 patients with advanced small-cell anaplastic carcinoma of the lung. The combination of vincristine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), cyclophosphamide, and methotrexate was significantly superior to the com...
journal_title：Annals of internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.7326/0003-4819-89-2-177
更新日期：1978-08-01 00:00:00
abstract：BACKGROUND:Some health plans profile physicians on the basis of their relative costs and use these profiles to assign physicians to cost categories. Physician organizations have questioned whether the rules used to attribute costs to a physician affect the cost category to which that physician is assigned. OBJECTIVE:T...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-152-10-201005180-00005
更新日期：2010-05-18 00:00:00
abstract：:For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infecti...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-91-6-872
更新日期：1979-12-01 00:00:00
abstract：SOURCE CITATION:Baldetti L, Melillo F, Moroni F, et al. Meta-analysis comparing P2Y12 inhibitors in acute coronary syndrome. Am J Cardiol. 2020;125;1815-22. 32305225. ...
journal_title：Annals of internal medicine
pub_type： 评论,杂志文章
doi：10.7326/ACPJ202009150-027
更新日期：2020-09-15 00:00:00
abstract：:We studied renal plasma flow and glomerular filtration rate during graded blood pressure reduction induced with sodium nitroprusside infusion in 16 hypertensive patients with atherosclerotic renovascular disease. Eight patients with unilateral disease tolerated pressure reduction from 205 +/- 9 (SE)/103 +/- 2 mm Hg to...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-102-3-308
更新日期：1985-03-01 00:00:00
abstract：:We compared the effects of quinidine and three alternate antiarrhythmic drugs on serum digoxin concentration in 63 patients before and during administration of quinidine, procainamide, disopyramide, or mexiletine. Quinidine increased digoxin concentration by at least 0.5 nmol/L in 21 of 22 patients: Mean serum digoxin...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-92-5-605
更新日期：1980-05-01 00:00:00
abstract：:We treated 50 patients who ingested packets of cocaine and developed a protocol for conservative medical management. Of the 50 patients, only 3 required emergency surgery. Surgery was precipitated by signs and symptoms of bowel obstruction in all cases. Six patients chose elective surgery. The rest of the patients pas...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-100-1-73
更新日期：1984-01-01 00:00:00
abstract：BACKGROUND:Mucositis can be a serious complication of cancer treatment. Palifermin reduces mucositis when given in multiple doses to patients undergoing hematopoietic stem-cell transplantation. OBJECTIVE:To evaluate the efficacy of palifermin given as a single dose before each cycle in patients receiving multicycle ch...
journal_title：Annals of internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.7326/0003-4819-153-6-201009210-00003
更新日期：2010-09-21 00:00:00
abstract：:Opioid dependence is a chronic relapsing medical condition with substantial health and societal complications. Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a pr...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-137-8-200210150-00014
更新日期：2002-10-15 00:00:00
abstract：:To increase the utility of administrative databases, it has been recommended that they include disease-specific, patient-centered outcome measures. This paper reviews practical and theoretical considerations and the critical evidence to support this recommendation. The strengths and weaknesses of the recommended appro...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-127-8_part_2-199710151-00060
更新日期：1997-10-15 00:00:00
abstract：:Therapy of pulmonary hypertension is limited by the low potency and adverse effects of current pulmonary vasodilators. The hemodynamic effects of nitroglycerin in human pulmonary hypertension are not known. We administered nitroglycerin to nine patients with chronic pulmonary hypertension. Nitroglycerin increased card...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-99-1-9
更新日期：1983-07-01 00:00:00
abstract：PURPOSE:To review the current knowledge about breast cancer in black women--including epidemiology, risk factors, screening practices, pathology, clinical manifestations, treatment, and outcome--with emphasis on issues that might explain why the survival rate in this population of women is lower than that in white wome...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-124-10-199605150-00007
更新日期：1996-05-15 00:00:00
abstract：OBJECTIVE:To explore how frequently physicians lose medical malpractice cases despite providing standard care and to assess whether severity of patient injury influences the frequency of plaintiff payment. DESIGN:Retrospective cohort study. SETTING:Physicians from the state of New Jersey insured by one insurance comp...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-117-9-780
更新日期：1992-11-01 00:00:00
abstract：:Differences in blood levels of thyroid hormones have been reported when patients taking synthetic L-thyroxine were shifted from one manufactured form of the hormone to another. Because recent formulation changes have rendered these earlier data obsolete, we did a crossover study to determine differences in bioavailabi...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-102-6-770
更新日期：1985-06-01 00:00:00
abstract：BACKGROUND:The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century. OBJECTIVE:To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies. DESIGN:Compartmental epidemic model in conjunction with a Markov mod...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-151-12-200912150-00156
更新日期：2009-12-15 00:00:00
abstract：:Deficiency of fat-soluble vitamins (A,D,E, and K) was evaluated in 15 patients with exocrine pancreatic insufficiency secondary to chronic alcoholic pancreatitis. Mild to moderate steatorrhea was present in all patients despite oral pancreatic enzyme therapy for 27 +/- 4 months (mean +/- SE). Deficiency of a single fa...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-97-4-549
更新日期：1982-10-01 00:00:00
abstract：:The hospital-based generalist physician is a recent organizational innovation in health care in the United States. Does the hospitalist model provide improved health care? The answer to this question lies in a rigorous evaluation of the hospitalist system in the clinical setting. This paper describes key outcomes that...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-130-4-199902161-00010
更新日期：1999-02-16 00:00:00
