Future Health Care Delivery Research Articles

Gender homophily in preferences for physicians

Gender homophily in physician preference (desire for a physician of the same sex) and more general homophily preferences (race, religion, and gender) were investigated among a population of college undergraduate and health professional students for a variety of health problems. Findings indicated that gender homophily preference was stronger for men than for women. However, the preferences may not reflect antifemale physician prejudice, particularly “self-prejudice” of women clients. Male preferred their doctors to be men significantly more than did females, regardless of the health problem. More serious health problems requiring greater physician skill (cancer, heart disease) did not produce significantly greater preference for males than problems requiring a lesser amount of skill. It appeared that health problems requiring a greater degree of physical intimacy (e.g., complete physical exam, gynecological or prostate problem) or psychological intimacy (e.g., emotional problem) produced greater homophily preference. Whether or not the student had had experience in clinical settings as a preprofessional or professional student did not have an impact on homophily preferences. Implications for the future delivery of health care, especially increased numbers of women in medicine, are discussed.

Evaluation and Peer Review of the Role of Specialist and General Medical Units in a Teaching Hospital

The trend toward increasing specialization in the medical wards of teaching hospitals has important implications for future health care delivery and student teaching. A study of the likely implications of a change to a specialty oriented medical admission system at the Royal Adelaide Hospital has shown that already the general physicians are seeing little renal and endocrine disease and, that work satisfaction is greater on the specialty units than on the general medical units. Patient satisfaction marginally favoured the specialty units. A peer review audit method was introduced to try and discern whether the quality of care was significantly different on the two types of units. Most physicians cooperated in at least one or two audits which involved them in judgements about adequacy of casenotes, management decisions, follow-up arrangements, length of stay and investigations in randomly assigned specialty pairs of patients (cared for by specialist or general units). No clear-cut trend was discerned favouring specialist or generalist care amongst 17 randomly selected pairs, but this part of the study was never completed, perhaps partly because of lack of enthusiasm for it by busy clinicians. The importance of maintaining a model of generalism for medical students on the teaching hospital campus is discussed discussed in the light of the decline of the role of general physicians.

The School Health Service: Making Primary Care Effective

School health services could play an important role in the future delivery of preventive primary health care. Barriers to the achievement of this goal are deeply rooted in the institutions of education and medicine, and include an unwillingness to change traditional ways, territoriality, protective professionalism, fragmentation of services, bureaucracy, and lack of trust and communication between school and health personnel. The roles of the various professionals and the system itself must be reevaluated.

Communicable medicine: Cable television and health services

Cable television is here to stay. Moreover, it will develop into a widespread and sophisticated medium of communication, greatly surpassing its modest, rural beginnings. If this is so, how will the future delivery of health care be affected by this new technology? And more importantly, can the technology be harnessed to improve health services, perhaps even transform their very nature? These are the questions underlying this paper.Their discussion is separated into three potential application areas. Continuing professional education, public health information, and actual health services delivery. Specifically, the paper suggests that the most imminent applications will occur in the first area and the most consequential in the third. However, in none of the areas is the impact of cable technology likely to be insignificant. The paper also delineates many of the problems and uncertainties of implementing cable-based systems of telemedicine.