Utilization of pediatric health services in Jerusalem (original) (raw)

Abstract

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.

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References

  1. Tulchinsky TH, “The development of health services in Israel and in Judea/Samaria: Lessons learned”.Public Health Reviews 12:378–84, 1984.
    Google Scholar
  2. Statistical Abstract of Israel (36). Central Bureau of Statistics, Jerusalem, 1985.
  3. Use of Health Services Survey - 1981, Central Bureau of Statistics and Ministry of Health, Special Series No. 717, Jerusalem, 1983.
  4. Statistical Yearbook of Jerusalem (5) -1986, Bigelman S, ed. Hed Press Ltd., Israel, 1988.
  5. Nie N.H., Wallace H.C., Jenkins J.G. et al.Statistical Package of Social Sciences. New York, McGraw Hill, 1985.
    Google Scholar
  6. Becker M.H., The health belief model and sick role behavior.Health Educ Monogr 2:409–19, 1974.
    Google Scholar
  7. Palti H., Adler B., Hurvitz J. et al. Use of iron supplementation in infancy: a field trial.World Health Organization Bull 65:87–94, 1987.
    Google Scholar
  8. Foets M., Berghmans F., Janssens L. The Primary Health Care Project in Belgium: A survey of utilization of health services.Soc. Sci. Med. 20:181–90, 1985.
    Google Scholar
  9. Hulka B.S., Wheat J.R. Patterns of utilization: The patient perspective.Medical Care 23:438–60, 1985.
    Google Scholar
  10. Wan T.T., Soifer S.J. Determinants of physician utilization: A causal analysis.J. Health Soc. Behav. 15:100–8, 1974.
    Google Scholar
  11. Zinkin P.M., Cox C.A. Child health clinics and inverse care laws: evidence from a longitudinal study of 1878 pre-school children.Br. Med. J. 2:411–3, 1976.
    Google Scholar
  12. Bice T.W., Rabin D.L., Starfield B.H., et al. Economic class and use of physician services.Medical Care 11:287–96, 1973.
    Google Scholar
  13. Fergusson D.M., Dimond M.E., Horwood L.J., et al. The utilisation of preschool health and education services.Soc. Sci. Med. 19:1173–80, 1984.
    Google Scholar
  14. Guendelman S., Schwalbe J. Medical care utilization by Hispanic children: How does it differ from black and white peers?Medical Care 24:925–37, 1986.
    Google Scholar
  15. Schaefer E.J., Hughes J.R. Socioeconomic factors and MCH care.Medical Care 14:535–43, 1976.
    Google Scholar
  16. Scott-Samuel A. Don't they want our services?Lancet 23:412–3, 1980.
    Google Scholar
  17. Shuval J. Health in Israel: Patterns of equality and inequality. Paper presented at the_Meeting on Inequalities in Health_, W.H.O. Lisbon, September 1987.
  18. Kadushin C. Social class and the experience of ill health.Sociological Inquiry 34:67–78, 1964.
    Google Scholar
  19. Antanovsky A. Social class and illness: A reconsideration.Sociological Inquiry 37:311–3, 1967.
    Google Scholar
  20. Winter S.T., Lilos P. Prediction of hospitalization during infancy: scoring the risk of admission.Pediatrics 53:716–20, 1974.
    Google Scholar
  21. Winter S.T., Davies A.M., Harlap S. Scoring newborns for the risk of subsequent hospital admissions: Comparative findings in Jerusalem and Haifa.Isr. J. Med. Sci. 17:399–402, 1981.
    Google Scholar
  22. Statistical Abstract of Israel (39). Central Bureau of Statistics, Jerusalem, 1988.
  23. Gofin R., Palti H., Adler B. et al. Childhood injuries: A population based study of emergency room visits in Jerusalem.Perinatal and Pediatric Epidemiology 3:174–88, 1989.
    Google Scholar
  24. Feldman W. Well-baby visits: how many?Can. Med. Assoc. J. 130:849–50, 1984.
    Google Scholar
  25. Gilbert J.R., Feldman W., Siegel L.S., et al. How many well-baby visits are necessary in the first 2 years of life?Can. Med. Assoc. J. 130:857–61, 1984.
    Google Scholar
  26. Hoekelman R.A. Well-child visits revisited.Am. J. Dis. Child. 137:17–20, 1983.
    Google Scholar
  27. Kovan M.G. Health status of U.S. children and use of medical care.Public Health Reports 97:3–15, 1982.
    Google Scholar
  28. Hall D.M.B.Health for all children — a programme for child health surveillance. U.K.: Oxford Medical Publications, 1989, p. 19.
    Google Scholar
  29. Alpert J.J., Kosa J., Haggerty R.J. et al. Attitudes and satisfactions of low-income families receiving comprehensive pediatric care.Am. J. Pub. Health 60:499–506, 1970.
    Google Scholar
  30. Gordis L., Markowitz M. Evaluation of the effectiveness of comprehensive and continuous pediatric care.Pediatrics 48:766–76, 1971.
    Google Scholar
  31. Lewis C. What is the evidence for comprehensive care?Amer. J. Dis. Child. 122:467–82, 1971.
    Google Scholar
  32. Butler J.Child health surveillance in primary care: a critical review. H.M.S.O., London, 1989.
    Google Scholar
  33. State Commission of Inquiry into the Functioning and Efficiency of the Health System in Israel — Majority Opinion Report, Jerusalem: Government Printing Office, 1990, pp. 341–362.
  34. Hart RH, Belsey MA, Tarimo E:Integrating maternal and child health services with primary health care: practical considerations. Geneva: World Health Organization, 1990, p. 84.
    Google Scholar

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Authors and Affiliations

  1. School of Public Health & Community Medicine, P.O. Box 1172, 91010, Jerusalem, Israel
    Hava Palti MD, MPH

Authors

  1. Yehuda Neumark MPH
  2. Hava Palti MD, MPH
  3. Milka Donchin MD, MPH
  4. Avi-Yacar Ellencweig PhD, MPH, MBA

Additional information

H. Palti is Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah Medical Organization, and Director, School of Public Health and Community Medicine, Hebrew University-Hadassah; Y. Neumark is instructor at the School of Public Health and Community Medicine, Hebrew University-Hadassah; M. Donchin is a member of the Department of Social Medicine, Hadassah Medical Organization; A.Y. Ellencweig is a member of the Department of Medical Ecology, Hebrew University-Hadassah.

Acknowledgement: The research on “Utilisation of health services” was supported by Hadassah Medical Organisation, The Jerusalem Municipality, the Ministry of Health and the Labour Sick Fund. It is the first in a series of papers on the utilisation of health services. Part of this publication is based on the MPH thesis of Y. Neumark tutored by H. Palti.

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Neumark, Y., Palti, H., Donchin, M. et al. Utilization of pediatric health services in Jerusalem.J Community Health 17, 271–282 (1992). https://doi.org/10.1007/BF01324357

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