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Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain con troversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories-functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers- to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. [ABSTRACT FROM AUTHOR]

This paper uses an institutional perspective (Scott, 1994; 2001; DiMaggio and Powell, 1991) to analyze the history and current state of the American health care field in terms of the alignment of its normative, cognitive, and regulatory elements. I depict the relation between institutional elements in each of three historical eras of the health care field (Scott et al 2000): the era of professional dominance (1945-1965), the era of federal involvement (1966-1982), and the era of managerial control and market mechanisms (after 1983 to the present). I argue that a weakening of alignment between these elements, beginning in the 1970s and increasing in the 1980s, led to consumer and provider dissatisfaction with managed care, and that the state of the field in the beginning of the 21st century suggests that a new era is emerging with renewed alignment between normative beliefs and values, cognitive models, and regulation. Implications for the future of health care and institutional theory are discussed. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control In this context, the papers of this special issue are then introduced. [ABSTRACT FROM AUTHOR]

A selective systematic overview is provided of the literature on the utilization of health and welfare services that appeared in the United States and Europe, mainly within the last two decades. Methodological questions that appear to characterize much of the work to date, are discussed and analytically distinct approaches or research strategies in the study of utilization behavior are presented. The paper traces the emergence of work in this area, questions the wisdom of investigators proceeding along traditional research lines, and highlights a number of promising new possibilities for research. [ABSTRACT FROM AUTHOR]

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however; consistently explored interactions between different features of socio economic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socio economic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover; education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy. [ABSTRACT FROM AUTHOR]

Using longitudinal data from the Toledo Adolescent Relationships Study, we examine the relationship between intimate partner violence (IPV) and depressive symptoms during adolescence and young adulthood (N = 1,273) while controlling for time-stable and time-varying correlates. Results show temporal changes in depressive symptoms, such that increases in depressive symptoms correspond to IPV exposure. While prior work has theorized that certain populations may be at increased psychological vulnerability from IPV, results indicate that both perpetration and victimization are associated with increases in depressive symptoms for both men and women, and irrespective of whether IPV exposure occurred in adolescence or young adulthood. Cumulative exposure to IPV does not appear to increase depressive symptoms beyond the effect observed for the most recent IPV exposure, but physical maltreatment by a parent does appear to diminish the association between IPV perpetration and depressive symptoms for a small subset of the sample. [ABSTRACT FROM PUBLISHER]

Using the 2004 Behavioral Risk Factor Surveillance System, we explore the relationship between racial awareness, perceived discrimination, and self-rated health among black (n = 5,902) and white (n = 28,451) adults. We find that adjusting for group differences in racial awareness and discrimination, in addition to socioeconomic status, explains the black-white gap in self-rated health. However, logistic regression models also find evidence for differential vulnerability among black and whites adults, based on socioeconomic status. While both groups are equally harmed by emotional and/or physical reactions to race-based treatment, the negative consequences of discriminatory experiences for black adults are exacerbated by their poorer socioeconomic standing. In contrast, the association between racial awareness and self-rated health is more sensitive to socioeconomic standing among whites. Poorer health is more likely to occur among whites when they reflect at least daily on their own racial status—but only when it happens in tandem with mid-range educational achievement, or among homemakers. [ABSTRACT FROM PUBLISHER]

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate. [ABSTRACT FROM PUBLISHER]

Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General’s Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time. [ABSTRACT FROM PUBLISHER]

The increasing size of the Latino immigrant population in the United States underscores the need for a more complete understanding of the role that social context plays in influencing the health of immigrants and their children. This analysis explores the possibility that residential location influences the health-risk behaviors of Latino youth in Los Angeles County, California. The data come from the Los Angeles Family and Neighborhood Survey. We apply multivariate, multilevel Rasch models to two scales of adolescent health-risk behaviors (substance use and delinquency). The findings suggest that residence in Census tracts characterized by above-county-average levels of Latinos and above-county-average levels of poverty is associated with increased odds of health-risk behaviors for Latino adolescents, particularly for those born in the United States. The findings lend support to the contention, put forth in the segmented assimilation literature, that disadvantaged urban contexts increase the risk that U.S.-born children of immigrants will experience downward assimilation. [ABSTRACT FROM AUTHOR]

Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption. [ABSTRACT FROM AUTHOR]

Unlike other major adult social roles in the United States, parenthood does not appear to confer a mental health advantage for individuals. However, while research has examined parental status differences in emotional well-being, relatively little is known about variations in emotional distress among parents. In this article, we clarify the relationship between parenthood and current symptoms of depression using data from the National Survey of Families and Households. The analyses provide support for our first hypothesis: Parenthood is not associated with enhanced mental health since there is no type of parent who reports less depression than nonparents. We also find support for our second hypothesis: Certain types of parenthood are associated with more depression than others. Additionally, although we find marital status differences in symptoms among parents, there are no gender differences in the association between parenthood and depression. We discuss the implications of our findings for ongoing theoretical debates about the advantages of social role involvement for mental health as well as the meaning of contemporary parenthood in the United States. [ABSTRACT FROM AUTHOR]

The managed care backlash is analyzed as a collective behavioral response led by attacks from threatened professional, provider, and special interest communities. Central to the backlash was the middle class `s repudiation of explicit rationing at the point of service adopted by Health Maintenance Organizations (HMOs) and other managed care plans. Americans are accustomed to choice and autonomy in their health care utilization and reacted negatively to restrictions. Assisted by negative anecdotes in the media and allegations of the denial of needed services, opponents built a negative picture of managed care often inconsistent with the empirical evidence. They succeeded in arousing public anxiety that appropriate health care might not be available when people most needed it. The private centralization of large health plans made them an easy target for the media, politicians, and provider groups in opposition. These attacks and regulatory initiatives succeeded in diluting strong utilization management controls contributing to current difficulties of containing large health cost increases. [ABSTRACT FROM AUTHOR]

Despite the lack of confidence in government agencies to operate a nationalized health-care system in the United States, government agencies have significantly influenced the distribution and financing of health-care services in the market. Using the State of Florida as a case study, we examine the conditions under which a state health-care agency can consistently influence health-care market arrangements. We examined records from Florida's legislative sessions between 1965 and 1993 focusing on 27 legislative initiatives to involve the state's healthcare agencies in the health-care services market. Using Boolean qualitative comparative analysis (QCA), we examined the conditions that facilitated or inhibited legislative policy initiatives for state action in Florida's health-care services market. The cohesiveness of state administrative agency and legislative leadership is of primary importance. Fragmented interests among health-care providers and fiscally legitimate policy positions, whether those of state agencies or health-care providers, are important enabling factors for state action. [ABSTRACT FROM AUTHOR]

This study examines the effect of religion on subjective health in a sample of Black and White elderly adults living in a southern community of the United States. The analyses lead to several conclusions. First, the findings indicate that future analyses examining the link between religion and subjective health should incorporate measures of functional health. Second, the differences found between Blacks and Whites warrant separation by race in future studies of religion and health. Third, the effects of religion on subjective health seem to be greatest for those suffering from physical health problems. This last finding emphasizes the comfort role of religion suggested by other researchers. [ABSTRACT FROM AUTHOR]

Studies that employ screening inventories to assess depression in the general population consistently find that women report more symptoms than men. The present study investigates the hypothesis that relatively mild, if not clinically trivial, symptoms of distress largely account for the female excess in symptom reports. A confirmatory factor analysis of data from a 1978 central Wisconsin community survey of 1,026 adults was done, and the results support the hypothesis. The implications of such sources of measurement error for epidemiological investigations are discussed. [ABSTRACT FROM AUTHOR]

One major assumption underlying much of the health-care policy in the United States is articulated and submitted to empirical test in this study. The test assesses the relative impacts of health service resources and community structure on two measures of physical health status. All constructs are measured by multiple indicators at three points in time: 1950, 1960, and 1970. The parameters of the conceptual model are estimated by multiple regression techniques. A block-recursive test of the static model shows that health resources exert minimal net impacts on health status. The impact of community structure on health status is more pronounced. Further, an examination of beta coefficients shows that the relationship between health service resources and physical health status is not consistent with the postulated notion of how the health system affects health. An evaluation of change data over the twenty-year period was consistent with the static model. Probationary policy implications of the findings are offered. [ABSTRACT FROM AUTHOR]

This study introduces a social indicator of access to medical care--the symptoms-response ratio-- that reflects the difference between the number of visits in response to symptoms that actually occur and the number that a panel of physicians indicate is appropriate for these same symptoms. Findings on the index fro a national sample of the United States population affirm differentials in access that are generally thought to exist in terms of other access indicators (conventional use measures, insurance coverage, etc.). Nonwhites, rural farm people, the poor, and those who have no usual place to go for medical care were found to have less access to care than would be judged appropriate, based on the symptoms-response index. The index also suggests possible "over-utilization" among certain groups such as children and people who see specialists as their regular source of care. [ABSTRACT FROM AUTHOR]

The relationship between income and physician visits, especially the assumption that the poor underutilize physician services is reexamined and tested with data from a survey of Rhode Island residents. The National Center for Health Statistics publications on the Volume of Physician Visits show a changing pattern in the use of physician services among income groups during the interval between 1960 and 1968. These data are complemented by findings from a 1971 survey of Rhode Island adults that show an inverse relationship between income and physician visits. The inverse trend in the Rhode Island data goes beyond the national pattern of a flattening of income differentials. The tendency for lower income respondents to be more likely to report physician visits during the previous sixty days as compared to visits reported by persons with larger incomes persisted even when controls were introduced for a number of related factors such as age, the mode of health care delivery used, and the presence of restricted activity days during the time period being studied. The accessibility of publicly financed medical care was found to be associated with use of physician services. [ABSTRACT FROM AUTHOR]

The rehabilitation system in the 1970's will be markedly different in its structure and activities from what it was in the past. The bases for this prediction are the current challenges to the traditional model of professional-client relationships; an increase in activity on the part of the client and his family in the rehabilitation process; a changing ideology and value system concerned with the right rather than the privilege of individuals to have good medical care and rehabilitation; and the high financial costs of institutional care of the disabled. A proposed solution is to develop for the rehabilitation system a "built-in environment." [ABSTRACT FROM AUTHOR]

The development of a standardized instrument designed to measure the treatment environment of the mental hospital provided the basis for two separate works of Jay Jackson (1964, 1969). The present study is in part a partial re-analysis of this standardized instrument known as the "Characteristics of the Treatment Environment Scale" (CTE Scale). The analysis is based on a heterogeneous national sample of 18 state mental hospitals and results in the construction of a new instrument called the "Treatment Milieu Scales" (TMS). This present analysis includes shortening of the Jackson CTE instrument, the development of new factors, and a test of their predictive ability with respect to the therapeutic orientation of the treatment environment as measured by hospital effectiveness. These effectiveness measures include in-hospital indicators such as staff morale, quality of over-all care, psychiatric care, patient movement, and net release, as well as in-community measures including social adjustment, and medical (mental status) adjustment. Significant findings are obtained for the patient movement measures, while several partial correlations were found to be significant in all the other in-hospital measures except staff morale. The findings suggest the "humanistic" tradition of therapy is not necessarily the most appropriate when viewed from the perspective of in-community patient rehabilitation. [ABSTRACT FROM AUTHOR]