Journal of Health and Social Behavior
Опубликовано на портале: 23-03-2007Catherine Ross, John Mirowsky, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 317-329.
Authors developed and tested a model of client satisfaction with medical care in which sociodemographic characteristics of the physician affect client satisfaction under conditions of unmet expectations and a lack of choice. They hypothesized that in small fee-for-service practices such as solo practice, where the client chooses his or her physician, status characteristics of the doctor would be unrelated to client satisfaction. Conversely, in large prepaid group practices where the client is assigned a physician, nonnormative physician status characteristics would create lower client satisfaction. Because expectations are based on statistical norms, it was hypothesized that clients in large prepaid multispecialty groups would be most satisfied with physicians who fit the norm-middle-aged white males from higher status Protestant or Jewish backgrounds. In a sample of pediatricians and their clients, authors found their hypotheses to be strongly supported, with one modification-the relationship between client satisfaction and the physician's socioeconomic background is parabolic. Furthermore, the negative effect of nonnormative physician religious status on client satisfaction in large prepaid groups is offset by the client-physician match and by experience with the physician.
Опубликовано на портале: 23-03-2007Marie R. Haug, Bebe Levin Journal of Health and Social Behavior. 1981. Vol. 22. No. 3. P. 212-229.
Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation.
Returning to the Doctor: The Effect of Client Characteristics, Type of Practice, and Experiences with Care [статья]
Опубликовано на портале: 23-03-2007Catherine Ross, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 2. P. 119-131.
Although a number of policy-makers have suggested that previous experiences with medical care affect subsequent use of physician services, few researchers have examined the issue empirically. Authors divide the determinants of revisiting the doctor in pediatric practice into three categories: client characteristics, organizational characteristics, and characteristics of the doctor-client interaction; and we develop a causal model. Although race, income, and education have no direct effects on the frequency of returning to the doctor, they have indirect effects through the organization of health care and experiences within the health care system. Clients who are poorly educated tend to have consistently negative experiences with the health care delivery system. These experiences affect subsequent use of services. Positive experiences with the interpersonal, psychosocial aspects of the doctor-client interaction increase a client's proclivity to return to the doctor, while negative doctor-client interactions decrease the probability of returning to the doctor.