Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation
Titelübersetzung:Ungleichheit bei der medizinischen Versorgung in Deutschland? Theoretische und empirische Evidenz für den Facharztbesuch
Autor/in:
Gruber, Stefan; Kiesel, Markus
Quelle: Journal of Public Health, 18 (2010) 4, S 351-365
Inhalt: Aim: In view of increasing concern about a two-class system in the German health care sector, this study investigates the relevance of health insurance schemes and other socioeconomic characteristics to the level of specialist health care provision. Subjects and Methods: Referring to Ronald M. Andersen’s model of health care utilization and more content-based approaches, we implement a negative binomial hurdle regression to estimate the number of specialist visits within the last 12 months. Our data source is the German sample of the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004. Results: The results show that men’s number of specialist visits is markedly sensitive to predisposing and enabling factors, whereas women’s health care utilization depends less on such socioeconomic characteristics. With reference to previous findings concerning general practitioner consultation, the assumption of a bipolar health care system providing general practitioner care primarily to the statutory insured and specialist care to the privately insured is supported empirically as to men. Education, which is considered to be highly correlated with health lifestyles, has a positive effect on medical health care. Every additional year of education increases by about 10% the probability of men seeking specialist consultation. Furthermore, the results indicate an unfavorable situation for the self-employed concerning health care because of their specific employment situation and health insurance coverage. Discussion: The research results suggest the existence of relevant differences in the amount of specialist consultation according to health insurance and other socioeconomic features. Further research could concentrate on the question of whether these inequalities in utilization levels indicate overprovision or underprovision of ambulant health care. Moreover, we recommend longitudinal research that is particularly suited to detangle age and cohort effects.
Schlagwörter:theory-practice; Theorie; statistische Analyse; health care delivery system; Facharzt; Gesundheitswesen; compulsory health insurance; Federal Republic of Germany; Theorie-Praxis; private health insurance; private Krankenversicherung; man; gesetzliche Krankenversicherung; inequality; statistical analysis; Lebenserwartung; medical specialist; model; health care; life expectancy; Modell; Gesundheitsversorgung; woman; Mann; theory; Ungleichheit; Specialist consultation; Health care utilization; Health insurance; Supply-induced demand; Hurdle regression
Attitudinal and socio-structural determinants of cervical cancer screening and HPV vaccination uptake: a quantitative multivariate analysis
Titelübersetzung:Einstellung und soziostrukturelle Determinanten zu Gebärmutterkrebs-Screening und HP-Virus-Schutzimpfung: eine quantitativ-multivariate Analyse
Quelle: Journal of Public Health, 18 (2010) 2, S 179-188
Inhalt: Aim: The introduction of the human papillomavirus (HPV) vaccine enables for the first time in the history of cancer prevention the possibility of combating the major cause of a cancer even before its onset. The secondary prevention measure of cervical cancer screening has thus been complemented by a primary prevention measure. The aim of this study is to analyse the determinants of uptake of preventive measures against cervical cancer as a basis for comparing the determinants of screening attendance with those of HPV vaccination attendance. Subject and methods: A population-based representative survey comprising 760 randomly selected women aged 14 to 65 was performed in the German federal state of Mecklenburg-Western Pomerania. Prevention behaviour, attitudes towards cervical cancer screening and HPV vaccination, and knowledge about cervical cancer and HPV were investigated by means of a structured questionnaire. Descriptive analyses and multivariate logistic regression analyses were conducted to identify the determinants of screening and HPV vaccine uptake. Results: Attendance both at screening and at HPV vaccination was best predicted by attitudinal factors. Positive connotations of cancer prevention measures and utility expectations, fear of cancer and high subjective risk perception were conducive to attendance at screening and HPV vaccination. Screening attendance was less regular among women of lower socioeconomic status. In contrast, HPV vaccination uptake was higher for young women with lower educational attainment and lower social class. Knowledge did not impact prevention behaviour significantly. There is no trade-off between screening and vaccination attendance; the vast majority of respondents was aware of the necessity of regular screening attendance even when vaccinated against HPV. Conclusions: Uptake rates for existing primary and secondary prevention measures against cervical cancer can be enhanced by fostering perceptions of utility and positive connotations of regular screening and becoming vaccinated against HPV. Elderly women in particular should be encouraged to attend screening by means of a recall system. Given the low overall level of knowledge about cervical cancer and its risk factors, there is a need for education about the necessity and utility of prevention to reach women of all social classes.
Schlagwörter:Gesundheit; vaccination; Prävention; risk; cancer; determinants; preventive medical examination; prevention; sozioökonomische Faktoren; Federal Republic of Germany; Vorsorgeuntersuchung; Mecklenburg-Western Pomerania; Gesundheitsvorsorge; Gesundheitsverhalten; knowledge; attitude; Risiko; health care; Krankheit; socioeconomic factors; woman; Mecklenburg-Vorpommern; Krebs; Impfung; Determinanten; health behavior; Risikoabschätzung; health; illness; Wissen; risk assessment; Einstellung; Cervical cancer prevention; Cervical screening; HPV vaccination; Attitudes; Socio-structural determinants; soziostrukturelle Faktoren
Machtspiele im Krankenhaus: "doing gender" oder "doing profession"?
Titelübersetzung:Power Games in the Hospital—Doing Gender or Doing Profession?
Autor/in:
Sander, Kirsten
Quelle: Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 9 (2008) 1, 15 S
Inhalt: Anhand einer Situationsbeschreibung aus einer ethnographischen Studie wird die Interaktion von Krankenschwestern und Ärzten nach den darin erzeugten Geschlechter- und Professionskonstruktionen untersucht. Für die mikrosoziologische Rekonstruktion der szenischen Beschreibung aus dem Alltag der Zusammenarbeit von Pflege und Medizin werden die von Erving GOFFMAN (1977) entwickelten rahmenanalytischen Konzepte genutzt. Durch eine dem situierten Vollzug der Interaktion folgende Interpretation sollen die von den AkteurInnen wechselseitig wahrgenommenen und dargestellten Handlungen nach ihrer Wirksamkeit für die Hervorbringung von Geschlechter- und Professionsunterscheidungen befragt werden. Es wird gezeigt, dass die Interaktionen von Schwestern und ÄrztInnen zweiseitig gerahmt sind und prinzipiell Wechsel sowie Verknüpfungen von professionellen und geschlechterstereotypisierenden Rahmungen möglich sind. Ausgangspunkt für die beispielhafte Szene aus einer Chefvisite ist die "unklare" Rahmung der Situation. Die Deutungs- und Entscheidungsmacht der Medizin scheint kurzfristig durch die Intervention einer Schwester infrage gestellt zu ein. Durch die von der Schwester angefragte körperliche Selbstpräsentation des männlichen Stationsarztes transformiert die Szene in einen Geschlechterrahmen. Der Chefarzt "klärt den Rahmen" mit einem vieldeutigen Scherz. In der Interpretation wird ausgeführt, dass die besondere körperliche Sichtbarkeit des Arztes eine Inkongruenz zwischen Professions- und Geschlechterrahmen herstellte. Zur Lösung der bereits in der Intervention der Schwester liegenden Rahmenspannung wird das Geschlecht offensiv durch den Chefarzt "ins Spiel" gebracht. Dass es sich um ein "Machtspiel" handelt, wird am Ergebnis des Interaktionsprozesses verdeutlicht: Durch das gemeinsame Lachen der Ärzte werden die Werte und Bestrebungen der Pflegenden und/oder der Frauen disqualifiziert.
Inhalt: This paper discusses findings from a study of inter-professional interaction between doctors and nurses in a surgical ward. The aim of the research is to analyze the construction of gender, profession and hierarchy in the context of the everyday interactions between members of the professions of nursing and medicine in the hospital. Participant observation was undertaken in two medical and two surgical wards in three hospitals. The present paper provides a microanalysis of ethnographic data in which Erving GOFFMAN's "frame analysis" (1974) is used as a central analytical resource. Gender and profession are interpreted as ongoing accomplishments. Stereotyping impacts of gender and profession are discussed as different "frames," which change or are linked in the social situation. In this particular case, an outspoken nurse is shown as she disrupts the frame of the doctor's rounds by displaying the assistant doctor as an embodied male person, thus "keying" the professional frame in a gender frame. The senior doctor "clears the frame" by making an ambiguous joke. I argue that doing subordination and doing domination in nursing and medicine are enacted by such gender displays. The interpretation shows the "doctor-nurse game" (STEIN, 1967) as a gendered power game.
Schlagwörter:Professionalisierung; Arzt; Krankenhaus; power; nurse; interaction; Handlungsspielraum; hospital; professionalization; decision; Krankenschwester; Federal Republic of Germany; Handlungsorientierung; intervention; man; Intervention; scope of action; nursing staff; Stereotyp; Macht; Entscheidung; physician; Pflegepersonal; Doing Gender; stereotype; woman; Mann; doing gender; Interaktion; gender-specific factors; action orientation; Rahmenanalyse; Geschlechterkonstruktion; Medizin-Pflege-Interaktion; Ethnografie; frame analysis; construction of gender; interaction of doctors and nurses; hospital; ethnography
SSOAR Kategorie:Industrie- und Betriebssoziologie, Arbeitssoziologie, industrielle Beziehungen, Frauen- und Geschlechterforschung, Gesundheitspolitik
Flexibilisierung und Gendering von Erwerbsformen im Gesundheitssektor: eine Studie zur Professionalisierung und Dienstleistungsqualität in der ambulanten Versorgung in Bremen
Titelübersetzung:Flexibilization and gendering of types of economic activity in the health sector: a study of professionalization and quality of service in out-patient care in Bremen
Autor/in:
Kuhlmann, Ellen
Quelle: ZeS Report, 7 (2002) 1, S 9-12
Inhalt: "(Die Autorin) stellt eine Studie vor, die sich mit Professionalisierung und Dienstleistungsqualität in der ambulanten Versorgung beschäftigt. Diese Studie ist als gemeinsames Projekt der Abteilungen 'Geschlechterpolitik im Wohlfahrtstaat' und 'Gesundheitspolitik, Arbeits- und Sozialmedizin' angelegt. Die politisch praktischen Erträge des Projekts zielen zum Einen auf Handlungsspielräume für eine geschlechtergerechte Gestaltung der Erwerbsstrukturen im Gesundheitssektor; zum Anderen geht es um Gestaltungsspielräume in der ambulanten Gesundheitsversorgung und um Fragen der Dienstleistungsqualität. Mit der Konzentration des empirischen Teils der Studie auf die Region Bremen ist auch der Transfer von Forschungsergebnissen in die sozialpolitische Praxis angestrebt." (Autorenreferat)
Schlagwörter:ambulante Versorgung; outpatient care; Gesundheitsversorgung; health care; Professionalisierung; professionalization; woman; gender-specific factors; Gesundheitswesen; health care delivery system; Strukturwandel; structural change; Erwerbsform; type of economic activity; Gesundheitsberuf; health occupations; Frauenberuf; female profession; Flexibilität; flexibility; Dienstleistung; service; Qualität; quality; Geschlechterverhältnis; gender relations; Federal Republic of Germany
SSOAR Kategorie:Berufsforschung, Berufssoziologie, Frauen- und Geschlechterforschung, Gesundheitspolitik