Skip to main content
SpringerLink
Log in

Quality of health care for the disadvantaged

  • Review Article
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Literature review points out that: (a) differentials in health status between the disadvantaged and the nondisadvantaged persist, often to a large degree; (b) differentials in the overall amount of care received are less striking now than heretofore, but standardization by level of need demonstrates measurable discrepancies in health services provided to the disadvantaged compared with the nondisadvantaged; (c) the quality of health care for the disadvantaged is not strikingly poorer than care for the nondisadvantaged, but, in view of demonstrable shortcomings in the quality of health care in general, this is not viewed as a positive statement; and (d) attempts to improve quality of care for the disadvantaged have not had the hoped-for impact. Four new avenues are suggested for possible further research: increased patient responsibility, increased consumer knowledge, financial accountability, and quality assurance activities. Because of the likelihood of only marginal changes in health status, rigorous evaluation of any experimental program is emphasized.

During the last decade, many attempts have been made by private and governmental bodies to improve the health of the American people. In general, these efforts have focused on improving the health of members of disadvantaged groups and have included such diverse activities as building OEO health centers, developing maternal and infant care programs, and financing care for the elderly. During the last few years, a different movement, concerned with assuring high quality care for all people, has produced efforts such as quality assurance activities in health maintenance organizations, the Professional Standards Review Organization program, and the medical care evaluation program of the Joint Commission on the Accreditation of Hospitals. Consideration of these two issues, i.e., improving the health of disadvantaged groups and improving the quality of care for all people, has led to two policy-relevant questions: “Can the health of disadvantaged groups be substantially improved by assuring that a high level quality of care is delivered to them?” and “Can the quality of care delivered to disadvantaged groups be improved?” The purpose of this paper is to review some available data pertinent to both these issues and to suggest some ideas for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hare RL, Barnoon S:Medical Care Appraisal and Quality Assurance in the Office Practice of Internal Medicine. San Francisco, American Society of Internal Medicine, July 1973.

    Google Scholar 

  2. American Public Health Association:Minority Health Chart Book. Washington, D.C., Government Printing Office, 1974.

    Google Scholar 

  3. Kosa J, Antonovsky A, Zola IK:Poverty and Health, A Sociological Analysis. Cambridge, Mass., Harvard University Press, 1969.

    Google Scholar 

  4. National Center for Health Statistics:Vital and Health Statistics. U.S.P.H.S. Publication No. 1000, Series 3, 10, 11, 12, 13, 20, 21, and 22; various numbers. Washington, D.C., Government Printing Office, issued periodically.

  5. Koos EL:The Health of Regionville. Chapter 2, Illness in Regionville. New York, Columbia University Press, 1954.

    Google Scholar 

  6. Conover PW: Social class and chronic illness.Int J Health Serv 3 357–368, 1973.

    Google Scholar 

  7. Fielding JE, Nelson SH: Health care for the economically disadvantaged adolescent.Pediatr Clin North Am 20 975–988, 1973.

    Google Scholar 

  8. Wallace HM: The health of American Indian children.Health Serv Rep 87 867–876, 1972.

    Google Scholar 

  9. Wallace HM: The health of American Indian children. A survey of current problems and needs.Clin Pediatr 12 83–87, 1973.

    Google Scholar 

  10. McDermott W, Deuschle KW, Barnett CR: Health care experiment at Many Farms.Science 175 23–31, 1972.

    Google Scholar 

  11. Waldrop RH, Guy M, Cowgill DN: Health priorities in Lubbock, Texas, according to socioeconomic groups.Health Serv Rep 89 134–144, 1974.

    Google Scholar 

  12. Hammerman J: Health services: Their success and failure in reaching older adults.Am J Public Health 64 253–256, 1974.

    Google Scholar 

  13. Nikias MK: Social class and the use of dental care under prepayment.Med Care 6 381–393, 1968.

    Google Scholar 

  14. Richardson WC:Ambulatory Use of Physicians' Services in Response to Illness Episodes in a Low-Income Neighborhood. Research Series No. 29. Chicago, University of Chicago, Center for Health Administration Studies, 1971.

    Google Scholar 

  15. Greenlick MR, Freeborn DK, Colombo TJ, et al: Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program.Med Care 10 187–200, 1972.

    Google Scholar 

  16. Bice TW, Eichhorn RB, Fox PD: Socioeconomic status and use of physician service: A reconsideration.Med Care 10 261–271, 1972.

    Google Scholar 

  17. Davis K, Reynolds R:Impact of Medicare and Medicaid on Access to Medical Care. Conference on the Role of Health Insurance in the Health Services Section. New York, National Bureau of Economic Research, 1974.

    Google Scholar 

  18. Makover HB: The quality of medical care. Methodology of survey of the medical groups associated with the Health Insurance Plan of New York.Am J Public Health 41824–832, 1951.

    Google Scholar 

  19. Rosenfeld LS: Quality of medical care in hospitals.Am J Public Health 47856–865, 1957.

    Google Scholar 

  20. Peterson OL, Andrews LP, Spain RS, et al: An analytical study of North Carolina general practice: 1953–1954.J Med Educ 31Part 2: 1–165, 1956.

    Google Scholar 

  21. Huntley RR, Steinhauser R, White KL, et al: The quality of medical care: Techniques and investigation in the outpatient clinic.J Chronic Dis. 14630–642, 1961.

    Google Scholar 

  22. Bunker JP: Surgical manpower. A comparison of operations and surgeons in the United States and in England and Wales.N Engl J Med 282 135–144, 1970.

    Google Scholar 

  23. Eisele CW, Slee VN, Hoffman RG: Can the practice of internal medicine be evaluated?Ann Intern Med 44 144–161, 1956.

    Google Scholar 

  24. Lembcke PA: Measuring the quality of medical care through vital statistics based on hospital service areas. 1. Comparative study of appendectomy rates.Am J Public Health 42 276–286, 1952.

    Google Scholar 

  25. Fry J: Are all “T's and A's” really necessary?Br Med J 1 124–129, 1957.

    Google Scholar 

  26. Brook RH:Quality of Care Assessment: A Comparison of Five Methods of Peer Review. DHEW Publication No. HRA-74-3100. Washington, D.C., Department of Health, Education and Welfare, 1973.

    Google Scholar 

  27. Payne BC, Lyons TF:Method of Evaluating and Improving Personal Medical Care Quality: Episodes of Illness Study. Chicago, American Hospital Association, 1973.

    Google Scholar 

  28. Payne BC, Lyons TF:Method of Evaluating and Improving Personal Medical Care Quality: Office Care Study. Chicago, American Hospital Association, 1973.

    Google Scholar 

  29. Lebow, JC: Consumer assessments of the quality of medical care.Med Care 12 328–337, 1974.

    Google Scholar 

  30. Hulka BS, Zyzanski SJ, Cassel JC, et al: Satisfaction with medical care in a low-income population.J Chronic Dis 24 661–673, 1971.

    Google Scholar 

  31. McCleery RS, Keelty LT, Lam M, et al:One Life—One Physician. Washington, D.C., Public Affairs Press, 1971.

    Google Scholar 

  32. Shortridge MH: Quality of medical care in an outpatient setting.Med Care 12283–300, April 1974.

    Google Scholar 

  33. Coe RM, Brehm HP: Preventive health services and physician error.Soc Sci Med 7303–305, 1973.

    Google Scholar 

  34. Lockett BA, Williams KN:Foreign Medical Graduates and Physician Manpower in the United States. DHEW Publication No. (HRA) 74-30. Washington, D.C., Government Printing Office, 1974.

    Google Scholar 

  35. Stolley PD, Goddard JL: Prescription drug insurance for the elderly under Medicare.Am J Public Health 61574–581, 1971.

    Google Scholar 

  36. Furstenberg FF, Tayback M, Goldberg H, et al: Prescribing an index to quality of medical care: A study of the Baltimore City Medical Care Program.Am J Public Health 43 1299–1309, 1953.

    Google Scholar 

  37. Brook RH, Appel FA, Avery C, et al: Effectiveness of inpatient follow-up care.N Engl J Med 285 1509–1514, 1971.

    Google Scholar 

  38. Lewis CE: Variations in the incidence of surgery.N Engl J Med 281880–884, 1969.

    Google Scholar 

  39. Kessner DM, Snow CK, Singer J:Assessment of Medical Care in Children. Contrasts in Health Status, volume 3. Washington, D.C., National Academy of Sciences, 1974.

    Google Scholar 

  40. Miller MH: Who receives optimal medical care?J Health Soc Behav 14 176–182, 1973.

    Google Scholar 

  41. Morehead MA, Donaldson RS, Sanderson S, et al:A Study of the Quality of Hospital Care Secured by a Sample of Teamster Family Members in New York City. New York, Columbia University School of Public Health and Administrative Medicine, 1964.

    Google Scholar 

  42. Lyons TF, Payne BD: The quality of physicians' health care performance.JAMA 227925–928, 1974.

    Google Scholar 

  43. Fletcher SW, Appel FA, Bourgois M: Improving emergency room patient follow-up in a metropolitan teaching hospital.N Engl J Med 291385–388, 1974.

    Google Scholar 

  44. Starfield B, Sharp E: Ambulatory pediatric care: The role of the nurse.Med Care 6507–515, 1968.

    Google Scholar 

  45. Pozen MW: Effects of Physician Education and Administrative Support on Hospital Ambulatory Care. Doctor of Science Thesis, Baltimore, Md., Johns Hopkins University School of Hygiene and Public Health, May 1974.

  46. Shapiro S, Weiner L, Densen P: Comparison of prematurity and perinatal mortality in a general population and in a population of a prepaid group practice, medical care plan.Am J Public Health 48 170–185, 1958.

    Google Scholar 

  47. Shapiro S, Williams JJ, Yerby AS, et al: Patterns of medical use by the indigent aged under two systems of medical care.Am J Public Health 57784–790, 1967.

    Google Scholar 

  48. Shapiro S, Weinblatt E, Frank CW, et al: Social factors in the progress of men following first myocardial infarction.Milbank Mem Fund Q 48 37–50, No. 1, January 1970.

    Google Scholar 

  49. Gordis L, Markowitz M: Evaluation of the effectiveness of comprehensive and continuous pediatric care.Pediatrics 48 766–776, 1971.

    Google Scholar 

  50. Bullough B: The source of ambulatory health services as it relates to preventive care.Am J Public Health 64 582–590, 1974.

    Google Scholar 

  51. Goodrich CH, Olendzki MC, Reader GD:Welfare Medical Care: An Experiment. Cambridge, Mass., Harvard University Press, 1970.

    Google Scholar 

  52. Gilum RF: Federal regulation of medical practice and the black physician.J Natl Med Assoc 65254–255, 1973.

    Google Scholar 

  53. Bellin LE, Kavaler F: Policing publicly funded health care for poor quality, overutilization, and fraud—the New York City Medicaid experience.Am J Public Health 50 811–820, 1970.

    Google Scholar 

  54. Colombo TJ, Saward EW, Greenlick MR: Group practice plans in governmental medical care programs. IV. The integration of an OEO Health Program into a prepaid comprehensive group practice plan.Am J Public Health 59 641–650, 1969.

    Google Scholar 

  55. Bellin SD, Geiger HJ: Actual public acceptance of neighborhood health centers by the urban poor.JAMA 214 2147–2153, 1970.

    Google Scholar 

  56. Bellin SS, Geiger HF: The impact of a neighborhood health center on patients' behavior and attitudes relating to health care: A study of a low income housing project.Med Care 10 224–239, 1972.

    Google Scholar 

  57. Morehead MA: Evaluating quality of medical care in the neighborhood health center program of the Office of Economic Opportunity.Med Care 8 118–131, 1970.

    Google Scholar 

  58. Morehead MA, Donaldson RS, Servalli MR: Comparisons between OEO neighborhood health centers and other health care providers of ratings of the quality of health care.Am J Public Health 61 1294–1306, 1971.

    Google Scholar 

  59. Morehead MA, Donaldson R: Quality of clinical management of disease in comprehensive neighborhood health centers.Med Care 12 301–315, 1974.

    Google Scholar 

  60. Gordis L: Effectiveness of comprehensive-care programs in preventing rheumatic fever.N Engl J Med 89 331–335, 1973.

    Google Scholar 

  61. Hebel R, Tayback M, Entwisle G, et al: Prenatal care and prematurity. Baltimore: University of Maryland, Department of Preventive Medicine, 1971 (mimeo).

    Google Scholar 

  62. Gold EM, Stone ML, Rich H: Total maternal and infant care: An evaluation.Am J Public Health 59 1851–1856, 1969.

    Google Scholar 

  63. DeGeyndt W:Quality of Care: End Results Based on a Performance Reporting System. Minneapolis, Systems Development Project, Minnesota Systems Research, Inc., 1971.

    Google Scholar 

  64. Starfield B, Scheff D: Effectiveness of pediatric care: The relationship between processes and outcomes.Pediatrics 49 547–552, 1972.

    Google Scholar 

  65. Data Tabulation and Analysis, New Mexico Medicaid Program. Albuquerque, New Mexico, The Dikewood Corporation and the New Mexico Experimental Medical Care Review Organization, 1974 (mimeo).

  66. Dreyfuss EG, Minson R, Sbarbara JA, et al: Internal chart audits in a neighborhood health program: A problem oriented approach.Med Care 9 449–454, 1971.

    Google Scholar 

  67. Roemer MI, Gartside FE: Effect of peer review in medical foundations on qualifications of surgeons.Health Serv Rep 88 808–813, 1973.

    Google Scholar 

  68. Buck R, White KW: Peer review: Impact of a system based on billing claims.N Engl J Med 291 877–883, 1974.

    Google Scholar 

  69. Robbins LC, Hall JH:How to Practice Prospective Medicine. Indianapolis, Methodist Hospital of Indiana, 1970.

    Google Scholar 

  70. Prospective medicine: The case for doing health hazard appraisals.Patient Care, p. 106 and passim, October 1, 1974.

  71. Shenkin BN, Warner DC: Sounding board. Giving the patient his medical record: A proposal to improve the system.N Engl J Med 289 688–691, 1973.

    Google Scholar 

Download references

Authors
  1. Robert H. Brook M.D., Sc.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen N. Williams M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dr. Brook is Assistant Professor of Medicine at the University of California at Los Angeles and Senior Staff Health Services Researcher at The Rand Corporation, Santa Monica, California. Ms. Williams is with The Rand Corporation. The research reported was performed pursuant to Grant No. D-90088 from the Office of Economic Opportunity, Washington, D.C. The options and conclusions expressed are solely those of the authors and should not be construed as representing the opinions or policy of any agency of the United States Government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brook, R.H., Williams, K.N. Quality of health care for the disadvantaged. J Community Health 1, 132–156 (1975). https://doi.org/10.1007/BF01319207

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01319207

Keywords

Search

Navigation